Australians spend over $3.5 billion each year on complementary medicines and therapies, most commonly to assist in the management of chronic disease and improve health and wellbeing.
Over the last twenty years, there has been a growing body of scientific knowledge on the efficacy of complementary medicine; understanding of mechanisms of action; and advances in processes to ensure quality and standardisation of materials and products. Research partnerships have increasingly focused on high burden of disease areas where mainstream medicine has yielded relatively poor results, particularly in the prevention and management of chronic disease, and towards enhanced results using a combination of complementary and mainstream interventions.
Once safety and efficacy have been established, a critical issue for consumers, practitioners and governments alike is understanding the cost effectiveness of medical interventions, whether mainstream or complementary.
In 2009, the National Institute of Complementary Medicine (NICM) commissioned Access Economics to undertake a series of cost effectiveness studies of selected complementary medicine interventions where a reasonable body of evidence for safety and efficacy was available. These were:
■ Acupuncture for chronic low back pain;
■ St John’s wort for mild to moderate depression;
■ Omega-3 fish oils for secondary prevention of heart disease;
■ Omega-3 fish oils to reduce non-steroidal anti-inflammatory drug use in rheumatoid arthritis; and
■ A proprietary herbal medicine for pain and inflammation of osteoarthritis.
Details of the analyses undertaken by Access Economics follow. It should be noted that only direct health costs are included in these analyses and indirect costs (such as loss of productivity at work) have been excluded. Cost savings would be expected to be higher if
indirect costs were included in the analyses.
The findings detailed in this report provide evidence that selected complementary medicine interventions represent cost effective treatment options in an Australian practice context for specific medical conditions. Further, interventions were cost effective despite the addition of
the GST to complementary medicine products.
■ acupuncture for chronic low back pain was found to be cost effective if used as a complement to standard care (medication, physiotherapy, exercises, education), although not generally cost effective when used as a replacement to standard care (unless co-morbidity of depression is included).
■ Based on analyses of recent clinical trials St John’s wort was determined to be cost effective compared to standard anti-depressants for patients with mild to moderate (not Cost effectiveness of complementary medicines severe) depression. The main driver for cost effectiveness is the lower unit cost of St John’s wort.
■ Fish oils rich in omega-3 fatty acids are highly cost effective when used as an adjunctive treatment in people with a history of coronary heart disease, achieving reduced death and morbidity. These findings are consistent with other international studies. Fish oils, however, were not cost effective in reducing non-steroidal anti-inflammatory drug use in rheumatoid arthritis.
■ Phytodolor , a proprietary herbal medicine, was found to be cost saving in managing osteoarthritis compared with the principal non-steroidal anti-inflammatory drug Diclofenac.
This report is an important component of advancing our knowledge and understanding of complementary medicine, and supporting informed choices for individual care. Studies of this type will also contribute to funding choices in the broader context of national health reforms. The findings strengthen the importance of ongoing research effort to determine and unlock the broader benefits of complementary medicines and therapies for the health of all Australians and to improve their use in an integrated healthcare practice environment.