Abstract
Objective: The practical implementation of a staged, multifaceted research agenda
for the economic evaluation of complementary medicine (CM) at the Royal London Homoeopathic
Hospital (RLHH).
Method: The relative importance of economic evaluation as an evidence base of CM was
assessed via a survey conducted with purchasers (n=481). The marginal costs of providing complementary care for patients with rheumatoid
arthritis were calculated. The use, and changes in the use, of conventional medicines
for patients’ main complaints were established retrospectively (n=499) and prospectively (n=70). Health-related quality of life (patient utility) of newly referred patients
was assessed with the EQ-5D (EuroQol) instrument (n=70) on a 100 mm (0=worst, 100=best) scale.
Results: Economic evaluation was rated ‘important’ as an evidence base, after safety
and RCT data (‘very important’). Consultation time (doctors and dietician) contributed
29% of the total costs of treating rheumatoid arthritis. The retrospective survey
showed that many patients on conventional medication were able to stop (29%) or reduce
(32%) intake in the course of treatment. The median (quartiles) health state of newly
referred patients was 70 mm (50,78) in men and 60 mm (36,73) in women. Some results
of an interim analysis of 6 months follow-up data are reported.
Conclusions: Economic evaluation of CM is becoming increasingly important and should
take place by using a multifaceted, staged approach. Before embarking on randomised
trials, observational data on cost, effectiveness and utility should be collected.
The cost-effectiveness of CM appears to be most sensitive to the duration of the consultation.
Keywords
economic evaluation - cost-effectiveness - EQ-5D - rheumatoid arthritis
