慢性腰痛に対する薬物鍼治療と理学療法の費用対効果分析：多施設共同実用化無作為化比較試験

Chronic low back pain (cLBP) is a significant global health issue, contributing to disability and economic strain. Nonpharmacological treatments, such as acupuncture and integrative approaches like pharmacopuncture (PPT), have shown potential in alleviating the burden of cLBP. This study aimed to evaluate the cost-effectiveness of PPT compared to physical therapy (PT) for managing cLBP from both healthcare system and societal perspectives.

A multicenter, two-arm randomized controlled trial was conducted, involving 100 patients with cLBP. Patients were randomized into either the PPT group or the PT group, receiving 10 treatment sessions over five weeks. Utility was measured using the EuroQol 5-Dimension 5-Level scale (EQ-5D-5L) to calculate quality-adjusted life years (QALYs), and costs were evaluated from healthcare and societal perspectives, including medical costs and productivity loss. Productivity loss was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the differences in costs by the differences in QALYs between the two groups. Bootstrapping and sensitivity analyses were performed to assess robustness.

PPT was more cost-effective than PT, particularly from a societal perspective where it demonstrated lower overall costs and improved QALY. From a healthcare system perspective, the ICER of PPT was 16,575 USD per QALY, indicating cost-effectiveness. Sensitivity analyses confirmed the robustness of these findings.

This study highlights PPT as a potentially cost-effective alternative to conventional PT for cLBP, though further research with larger sample sizes and extended follow-up is recommended to validate these results.

ClinicalTrials.gov (NCT04833309), Clinical Research Information Service (KCT0006088).