An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS)

ObjectivesTo assess the cost-effectiveness of acupuncture and usual care, and Alexander Technique lessons and usual care, compared with usual GP care alone for chronic neck pain patients.MethodsAn economic evaluation was undertaken alongside the ATLAS trial, taking both NHS and wider societal viewpoints. Participants were offered up to twelve acupuncture sessions or twenty Alexander lessons (equivalent overall contact time). Costs were in pounds sterling. Effectiveness was measured using the generic EQ-5D to calculate quality adjusted life years (QALYs), as well as using a specific neck pain measure–the Northwick Park Neck Pain Questionnaire (NPQ).ResultsIn the base case analysis, incremental QALY gains were 0.032 and 0.025 in the acupuncture and Alexander groups, respectively, in comparison to usual GP care, indicating moderate health benefits for both interventions. Incremental costs were £451 for acupuncture and £667 for Alexander, mainly driven by intervention costs. Acupuncture was likely to be cost-effective (ICER = £18,767/QALY bootstrapped 95% CI £4,426 to £74,562) and was robust to most sensitivity analyses. Alexander lessons were not cost-effective at the lower NICE threshold of £20,000/QALY (£25,101/QALY bootstrapped 95% CI -£150,208 to £248,697) but may be at £30,000/QALY, however, there was considerable statistical uncertainty in all tested scenarios.ConclusionsIn comparison with usual care, acupuncture is likely to be cost-effective for chronic neck pain, whereas, largely due to higher intervention costs, Alexander lessons are unlikely to be cost-effective. However, there were high levels of missing data and further research is needed to assess the long-term cost-effectiveness of these interventions.

研究目标：评估针灸联合常规照护、亚历山大技法（Alexander Technique）训练联合常规照护，相较于单纯全科医师常规照护，对慢性颈痛患者的成本效益。研究方法：本研究依托ATLAS临床试验开展经济学评价，同时纳入英国国民保健制度（National Health Service, NHS）及更广泛的社会视角。受试者可选择最多12次针灸疗程，或20节亚历山大技法训练课程（二者总干预接触时长相当）。成本以英镑计价。健康效用采用通用型EQ-5D量表计算质量调整生命年（Quality Adjusted Life Years, QALYs），同时采用特异性颈痛评估工具——北威克公园颈痛问卷（Northwick Park Neck Pain Questionnaire, NPQ）进行疗效评价。研究结果：基础案例分析显示，相较于单纯全科医师常规照护组，针灸组与亚历山大技法训练组的增量QALYs分别为0.032与0.025，提示两种干预措施均能带来中等程度的健康获益。针灸组的增量成本为451英镑，亚历山大技法训练组为667英镑，成本增量主要源于干预本身的花费。针灸疗法大概率具备成本效益（增量成本效果比（Incremental Cost-Effectiveness Ratio, ICER）为18767英镑/QALY，自助法bootstrap 95%置信区间为4426~74562英镑），且在多数敏感性分析中结果稳健。在英国国家卫生与临床优化研究所（National Institute for Health and Care Excellence, NICE）设定的20000英镑/QALY低阈值下，亚历山大技法训练组不具备成本效益（增量成本效果比为25101英镑/QALY，自助法bootstrap 95%置信区间为-150208~248697英镑）；但在30000英镑/QALY阈值下则可能具备成本效益，不过所有测试场景下均存在较大的统计学不确定性。研究结论：与常规照护相比，针灸疗法用于慢性颈痛患者具备较高的成本效益；而亚历山大技法训练因干预成本较高，整体不具备成本效益。但本研究存在大量缺失数据，仍需开展进一步研究以评估上述干预措施的长期成本效益。