Analytical approach:
This economic evaluation was based on a single study. The time horizon was 3 months. The authors stated that a societal perspective was adopted in the study.
Effectiveness data:
A multi-centre, randomised, clinical trial (RCT) in adult patients with primary headache was performed. A sample of 3,182 patients (77.4% women) was enrolled, of which 1,613 were in the acupuncture group and 1,569 in the control group. With the exception of disease duration, which was longer in the control group, the baseline characteristics of the study groups were comparable. Baseline differences were taken into account in a statistical test aimed at minimising the potential impact of confounding.
Monetary benefit and utility valuations:
Utility valuations were elicited at baseline and after 3 months from the sample of patients enrolled in the RCT using the Short Form (SF)-36 questionnaire.
Measure of benefit:
The summary benefit measure was the quality-adjusted life-years. Discounting was not required given the short time horizon of the analysis.
Cost data:
The analysis of the costs included acupuncture, physician visits, hospital stay, drugs (including patients’ co-payments) and lost workdays. Resource use was derived from data obtained from patients in the RCT, while the unit costs were based on data from the social health insurance funds. The human capital approach was used to estimate the indirect costs. The costs were in euros (EUR). The price year was not reported. Discounting was not relevant and was not applied.
Analysis of uncertainty:
A bootstrapping approach was used to transform the cost-utility ratios into net benefit values for different threshold values and to generate cost-effectiveness acceptability curves. Deterministic sensitivity analyses explored a variety of acupuncture cost scenarios and alternative durations of therapeutic and economic effects. Moreover, in a specific scenario, the authors reduced the benefit difference between the two treatments over time. Simultaneous variations in clinical and economic data and the use of discounting for both costs and benefits were also considered. Finally, sub-group analyses were performed (women versus men).