Research
General gynecology
Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care

https://doi.org/10.1016/j.ajog.2007.07.041Get rights and content

Objective

To investigate the clinical effectiveness and cost-effectiveness of acupuncture in patients with dysmenorrhea.

Study Design

In a randomized controlled trial plus non-randomized cohort, patients with dysmenorrhea were randomized to acupuncture (15 sessions over three months) or to a control group (no acupuncture). Patients who declined randomization received acupuncture treatment. All subjects were allowed to receive usual medical care.

Results

Of 649 women (mean age 36.1 ± 7.1 years), 201 were randomized. After three months, the average pain intensity (NRS 0-10) was lower in the acupuncture compared to the control group: 3.1 (95% CI 2.7; 3.6) vs. 5.4 (4.9; 5.9), difference −2.3 (−2.9; −1.6); P<.001. The acupuncture group had better quality of life and higher costs. (overall ICER €3,011 per QALY).

Conclusion

Additional acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life as compared to treatment with usual care alone and was cost-effective within usual thresholds.

Section snippets

Design

The Acupuncture in Routine Care (ARC) Study was a multicenter randomized controlled trial plus a nonrandomized cohort. Patients who agreed to randomization were allocated to an acupuncture group that received immediate acupuncture treatment for 3 months or to a control group that received delayed acupuncture treatment after 3 months. Patients who declined to be randomized were included in a third arm and also received immediate acupuncture treatment (nonrandomized acupuncture group) for 3

Patient inclusion, baseline characteristics, and treatment

Between January 2001 and August 2001 a total of 656 patients with pain due to dysmenorrhea were recruited for the study by 456 study physicians (see Figure 1 for patient selection). A total of 208 patients accepted randomization and were allocated to the acupuncture or the control group. Seven patients (3 acupuncture, 4 control) could not be included in the analysis because the study office did not receive the consent form or the patients did not receive the study intervention. The remaining

Comment

Patients with pain due to dysmenorrhea chronic treated with acupuncture in addition to routine care showed significant improvements in pain intensity and quality of life compared to patients who received routine care alone. In patients who consented to randomization, treatment outcomes after acupuncture were similar to those who declined randomization. Acupuncture treatment was associated with better quality of life as well as higher costs. This increase in costs was essentially due to

Acknowledgment

We thank Katja Wruck for data management, Iris Bartsch, Beatrice Eden, and Sigrid Mank for data acquisition, the members of the advisory board (Dr Konrad Beyer, Dr Josef Hummelsberger, Dr Bodo Liecker, Hardy Müller, Dr Albrecht Molsberger, Dr Helmut Rüdinger, Dr Wolfram Stör, Dr Gabriel Stux) for helpful advice and we thank all participating physicians and patients.

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    Cite this article as: Witt CM, Reinhold T, Brinkhaus B, et al. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol 2008;198:166.e1-166.e8.

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