Search

Your search keyword '"Whitehurst, David G.T."' showing total 13 results
Start Over Author "Whitehurst, David G.T."
13 results on '"Whitehurst, David G.T."'

8. Cost-effectiveness of acupuncture care as an adjunct to exercise-based physical therapy for osteoarthritis of the knee

Author

Whitehurst, David G.T., Bryan, Stirling, Hay, Elaine M., Thomas, Elaine, Young, Julie, and Foster, Nadine E.

Subjects
Medical care, Cost of -- Research, Therapeutics, Physiological -- Economic aspects, Outcome and process assessment (Health Care) -- Research, Physical therapy -- Economic aspects, Osteoarthritis -- Care and treatment -- Standards -- Diagnosis, Acupuncture -- Economic aspects, Health
Abstract

Background. The delivery of acupuncture alongside mainstream interventions and the cost-effectiveness of 'alternative' treatments remain areas of controversy. Objective. The aim of this study was to assess the cost-utility of adding acupuncture to a course of advice and exercise delivered by UK National Health Service (NHS) physical therapists to people with osteoarthritis of the knee. Design. A cost-utility analysis was performed alongside a randomized controlled trial. Methods. A total of 352 adults (aged 50 years or older) were randomly assigned to receive I of 3 interventions. The primary analysis focused on participants receiving advice and exercise (AE) or advice and exercise plus true acupuncture (AE+TA). A secondary analysis considered participants receiving advice and exercise plus nonpenetrating acupuncture (AE+NPA). The main outcome measures were quality-adjusted life years (QALYs), measured by the EQ-5D, and UK NHS costs. Results were expressed as the incremental cost per QALY gained over 12 months. Sensitivity analyses included a broader cost perspective to incorporate private out-of-pocket costs. Results. NHS costs were higher for AE+TA (314 £ [British pounds sterling]) than for AE alone (229 £), and the difference in mean QALYs favored AE+TA (mean difference=0.022). The base-case cost per QALY gained was 3,889 £; this value was associated with a 77% probability that AE+TA would be more cost-effective than AE at a threshold of 20,000 £ per QALY. Cost-utility data for AE+NPA provided cost-effectiveness estimates similar to those for AE+TA. Limitations. As with all trial-based economic evaluations, caution should be exercised when generalizing results beyond the study perspectives. Conclusions. A package of AE+TA delivered by NHS physical therapists provided a cost-effective use of health care resources despite an associated increase in costs. However, the economic benefits could not be attributed to the penetrating nature of conventional acupuncture; therefore, further research regarding the mechanisms of acupuncture is needed. An analysis of alternative cost perspectives suggested that the results are generalizable to other health care settings., Like many common disabling conditions, osteoarthritis imposes a sizeable economic burden on society, with cost-of-illness estimates accounting for 1% to 2.5% of the gross national product in several developed countries. [...]

Published
2011
Full Text
View/download PDF

13. Inconsistencies in NICE guidance for acupuncture: reanalysis and discussion.

Author

Latimer, Nichoas R, Chandrika Bhanu, Aathish, and Whitehurst, David G.T.

Subjects
TREATMENT of backaches, KNEE disease treatment, OSTEOARTHRITIS treatment, ACUPUNCTURE, ALTERNATIVE medicine, COST effectiveness, MEDICAL protocols, MEDICAL societies
Abstract

Background Acupuncture received a positive recommendation in the National Institute for Health and Clinical Excellence (NICE) clinical guideline for low back pain (LBP). However, no such recommendation was forthcoming in the NICE clinical guideline for osteoarthritis (OA). Importantly,the two guidelines adopted different treatment comparators in their economic analyses of acupuncture; in the LBP guideline ‘usual care’ was used (with no consideration of placebo/sham interventions), whereas ‘sham acupuncture’ was the comparator in the OA guideline. Objective To analyse the implications of using different control group comparators when estimating the cost-effectiveness of acupuncture therapy. Methods The NICE OA economic analysis for acupuncture was replicated using ‘usual care’ (ie, no placebo/sham component) as the treatment comparator. A ‘transfer-to-utility’ technique was used to transform Western Ontario and McMaster Osteoarthritis scores into EQ-5D utility scores to allow quality-adjusted life year (QALY) gains to be estimated. QALY estimates were combined with direct incremental cost estimates of acupuncture treatment to determine incremental cost effectiveness ratios (ICERs). Results When ‘usual care’ was used as the treatment comparator, ICER point estimates were below £20 000 per QALY gained for each acupuncture trial analysed in the OA clinical guideline. In the original analysis, using placebo/sham acupuncture as the treatment comparator, ICERs were generally above £20 000 per QALY gained. Conclusion The treatment comparator chosen in economic evaluations of acupuncture therapy is likely to be a strong determinant of the cost effectiveness results. Different comparators used in the OA and LBP NICE guidelines may have led to the divergent recommendations in the guidelines. [ABSTRACT FROM AUTHOR]

Published
2012
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results