A MARKOV MODEL-BASED COST-EFFECTIVENESS ANALYSIS OF ACUPUNCTURE FOR NON-SPECIFIC LOW BACK PAIN IN HONG KONG
Author(s)
Yingcheng Wang, PhD1, Kwok Yin Au, MD2, Lai Yim, MA1, Mingjun Rui, MSc1, Qiran Wei, MSc1, Jiaqi Shi, MSc1, Joyce You, PharmD1;
1The Chinese University of Hong Kong, School of Pharmacy, Faculty of Medicine, Hong Kong SAR, China, 2The Chinese University of Hong Kong, Integrative Medical Centre, School of Chinese Medicine, Hong Kong SAR, China
1The Chinese University of Hong Kong, School of Pharmacy, Faculty of Medicine, Hong Kong SAR, China, 2The Chinese University of Hong Kong, Integrative Medical Centre, School of Chinese Medicine, Hong Kong SAR, China
OBJECTIVES: Non-specific low back pain is a common cause of disability and healthcare utilization and is mainly managed with oral western medications despite limited benefit and concerns regarding adverse events. Acupuncture is recommended in clinical guidelines, yet its cost-effectiveness in Hong Kong remains uncertain. This study evaluated the cost-effectiveness of acupuncture compared with usual oral medications from the perspective of the Hong Kong healthcare provider.
METHODS: A Markov model with a monthly cycle length was developed to simulate one-year outcomes for a hypothetical cohort of adults receiving outpatient treatment for non-specific low back pain. Two treatment strategies were evaluated: (1) acupuncture, and (2) usual western oral medications. The model included four pain-related health states: no pain, low impact pain, moderate impact pain, and high impact pain. Model inputs were obtained from published literature and public data. Primary outcomes included time spent in the no pain state, direct medical costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Base case and sensitivity analyses were conducted.
RESULTS: In the base case analysis, acupuncture resulted in a longer duration in the no pain state compared with usual western oral medications (4.26 months vs 3.93 months). The expected cost and QALYs for usual western oral medications were USD79 and 0.7541 QALYs per patient. Acupuncture resulted in higher effectiveness (0.7565 QALYs) at higher cost (USD128). The ICER for acupuncture (versus usual western oral medications) was 20,786 USD/QALY gained, lowering than the willingness-to-pay (WTP) threshold of 54,101 USD/QALY gained. One-way sensitivity analysis identified the cost of acupuncture as an influential parameter. The probability of acupuncture being cost-effective at the WTP threshold of 54,101 USD/QALY gained was 95.46%.
CONCLUSIONS: Acupuncture improved clinical outcomes at higher cost compared with usual western oral medications. The cost-effectiveness acceptance of acupuncture was subject to the cost of acupuncture.
METHODS: A Markov model with a monthly cycle length was developed to simulate one-year outcomes for a hypothetical cohort of adults receiving outpatient treatment for non-specific low back pain. Two treatment strategies were evaluated: (1) acupuncture, and (2) usual western oral medications. The model included four pain-related health states: no pain, low impact pain, moderate impact pain, and high impact pain. Model inputs were obtained from published literature and public data. Primary outcomes included time spent in the no pain state, direct medical costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Base case and sensitivity analyses were conducted.
RESULTS: In the base case analysis, acupuncture resulted in a longer duration in the no pain state compared with usual western oral medications (4.26 months vs 3.93 months). The expected cost and QALYs for usual western oral medications were USD79 and 0.7541 QALYs per patient. Acupuncture resulted in higher effectiveness (0.7565 QALYs) at higher cost (USD128). The ICER for acupuncture (versus usual western oral medications) was 20,786 USD/QALY gained, lowering than the willingness-to-pay (WTP) threshold of 54,101 USD/QALY gained. One-way sensitivity analysis identified the cost of acupuncture as an influential parameter. The probability of acupuncture being cost-effective at the WTP threshold of 54,101 USD/QALY gained was 95.46%.
CONCLUSIONS: Acupuncture improved clinical outcomes at higher cost compared with usual western oral medications. The cost-effectiveness acceptance of acupuncture was subject to the cost of acupuncture.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE243
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)