Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain

Objective: To evaluate the cost effectiveness of acupuncture in the management of persistent non-specific low back pain. Design: Cost effectiveness analysis of a randomised controlled trial. Setting: Three private acupuncture clinics and 18 general practices in York, England. Participants: 241 adults aged 18-65 with non-specific low back pain of 4-52 weeks' duration. Interventions: Ten individualised acupuncture treatments over three months from acupuncturists trained in traditional Chinese medicine (n = 160) or usual care only (n = 81). Main outcome measure: Incremental cost per quality adjusted life year (QALY) gained over two years. Results: Total costs to the United Kingdom's health service during the two year study period were higher on average for the acupuncture group (£460; 673; $859) than for the usual care group (£345) because of the costs associated with initial treatment. The mean incremental health gain from acupuncture at 12 months was 0.012 QALYs (95% confidence interval -0.033 to 0.058) and at 24 months was 0.027 QALYs (-0.056 to 0.110), leading to a base case estimate of £4241 per QALY gained. This result was robust to sensitivity analysis. The probabilistic sensitivity analysis showed acupuncture to have a more than 90% chance of being cost effective at a £20 000 cost per QALY threshold. Conclusion: A short course of traditional acupuncture for persistent non-specific low back pain in primary care confers a modest health benefit for minor extra cost to the NHS compared with usual care. Acupuncture care for low back pain seems to be cost effective in the longer term. Trial registration: ISRCTN8076417