Possible paths of economic assessment for integrative and complementary practices in chronic conditions

Aquino, Camilla Maria Ferreira de; Bezerra, Adriana Falangola Benjamin; Sousa, Islândia Maria Carvalho de

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Brasil

Physis: Revista de Saúde Coletiva

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Brasil

Español English

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Sumário

ARTIGO ORIGINAL • Physis 34 • 2024 • https://doi.org/10.1590/S0103-7331202434011pt copy

Possible paths of economic assessment for integrative and complementary practices in chronic conditions

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives

To analyze economic evaluation designs in Integrative and Complementary Health Practices (PICS).

Methods

This study is an integrative review of available studies in the Virtual Health Library, from 2009 to 2021.

Results

Twenty-one studies were selected for final analysis, showing significant compliance with the experts’ recommendations. In general, the population consisted of adult women with musculoskeletal disorders, who received manipulative therapies, acupuncture/acupressure and homeopathy. To evaluate these interventions, society's or provider's perspectives were used, based on cost-effectiveness and cost-consequence analyses, focusing on estimating direct health costs, and sometimes indirect costs. As for outcomes, most studies collected more than one measure, mainly related to symptomatic manifestations, overall well-being and/or psychosocial factors.

Conclusions

The economic evaluation is evolving to consider broader perspectives, with a greater variety of costs and results, adapting to different intervention scenarios, meeting the specificities of PICS. Reconciling methodological design and PICS’ context of insertion in Brazil is possible and necessary, given the lack of national assessments, the biases generated by international comparisons, and the disputes over the sustainability of this set of practices in the Brazilian Unified Healht System.

Keywords:
Complementary Therapies; Cost-Benefit Analysis; Chronic Disease; Health Planning Support

(“Complementary Therapies” OR “Alternative Therapies” OR “Therapy, Alternative” OR “Therapy, Complementary” OR “Therapies, Alternative” OR “Therapies, Complementary” OR “Medicine, Alternative” OR “Complementary Medicine” OR “Medicine, Complementary” OR “Alternative Medicine” OR “Plant Magnetism” OR “Complementary and Integrative Health Practices” OR “Complementary and Integrative Medicine” OR “Complementary and Integrative Practices” OR “Integrative and Complementary Health Practices” OR “Integrative and Complementary Medicine” OR “Integrative and Complementary Practices”) AND (“Analyses, Cost Benefit” OR “Analyses, Cost-Benefit” OR “Analyses, Cost-Utility” OR “Analyses, Marginal” OR “Analysis, Cost Benefit” OR “Analysis, Cost-Benefit” OR “Analysis, Cost-Effectiveness” OR “Analysis, Cost-Utility” OR “Analysis, Marginal” OR “Benefits and Costs” OR “Cost Benefit” OR “Cost Benefit Analyses” OR “Cost Benefit Analysis” OR “Cost Benefit Data” OR “Cost Effectiveness” OR “Cost Effectiveness Analysis” OR “Cost Utility Analysis” OR “Cost-Benefit Analyses” OR “Cost-Benefit Analysis” OR “Cost-Benefit Data” OR “Cost-Effectiveness Analysis” OR “Costs and Benefits” OR “Cost-Utility Analyses” OR “Cost-Utility Analysis” OR “Data, Cost-Benefit” OR “Economic Evaluation” OR “Economic Evaluations” OR “Effectiveness, Cost” OR “Evaluation, Economic” OR “Evaluations, Economic” OR “Marginal Analyses” OR “Marginal Analysis” OR “Clinical Effectiveness” OR “Clinical Effectiveness” OR “Clinical Efficacy” OR “Effectiveness” OR “Effectiveness, Clinical” OR “Effectiveness, Treatment” OR “Effectiveness, Clinical” OR “Efficacy” OR “Efficacy, Clinical” OR “Efficacy, Treatment” OR “Evaluation of the Efficacy-Effectiveness of Interventions” OR “Outcome, Patient-Relevant” OR “Outcome, Rehabilitation” OR “Outcome, Treatment” OR “Outcomes, Patient-Relevant” OR “Patient Relevant Outcome” OR “Patient-Relevant Outcome” OR “Patient-Relevant Outcomes” OR “Rehabilitation Outcome” OR “Treatment Effectiveness” OR “Treatment Efficacy” OR “Treatment Outcome”)

Autoria (ano de publicação)	Resultados de conformidade*
Autoria (ano de publicação)	A	B	C	D	E	F	G	Total
Grieves; Menke; Pursel (2009)GRIEVES, B.; MENKE, J. M.; PURSEL, K. J. Cost minimization analysis of low back pain claims data for chiropractic vs medicine in a managed care organization. Journal of manipulative and physiological therapeutics, Oxford, v. 32, n. 9, p. 734-739, 2009.	2	1	2	0	2	1	2	10
Pomposellil et al. (2009)POMPOSELLI, R. et al. Observational study of homeopathic and conventional therapies in patients with diabetic polyneuropathy. Homeopathy, London, v. 98, n. 01, p. 17-25, 2009.	1	1	1	2	1	1	1	8
Rossi et al. (2009ROSSI, E. et al. Cost–benefit evaluation of homeopathic versus conventional therapy in respiratory diseases. Homeopathy, London, v. 98, n. 01, p. 2-10, 2009.)	1	2	2	2	1	2	2	12
Sharma et al. (2009SHARMA, R. et al. Determinants of costs and pain improvement for medical and chiropractic care of low back pain. Journal of manipulative and physiological therapeutics, Oxford, v. 32, n. 4, p. 252-261, 2009.)	1	1	1	2	2	1	1	9
Witt et al. (2009WITT, C. M. et al. Cost-effectiveness of acupuncture in women and men with allergic rhinitis: a randomized controlled study in usual care. American journal of epidemiology, Baltimore, v. 169, n. 5, p. 562-571, 2009.)	2	2	2	2	2	2	2	14
Hamre et al. (2010HAMRE, H. J. et al. Health costs in patients treated for depression, in patients with depressive symptoms treated for another chronic disorder, and in non-depressed patients: a two-year prospective cohort study in anthroposophic outpatient settings. The European Journal of Health Economics, Berlin, v. 11, n. 1, p. 77-94, 2010.)	2	2	2	2	2	1	2	13
Kim et al. (2010KIM, N. et al. An economic analysis of usual care and acupuncture collaborative treatment on chronic low back pain: a Markov model decision analysis. BMC complementary and alternative medicine, London, v. 10, n. 1, p. 1-12, 2010.)	2	2	2	2	2	2	2	14
Zuzak et al. (2010ZUZAK, T. J. et al. Medicinal systems of complementary and alternative medicine: a cross-sectional survey at a pediatric emergency department. The Journal of Alternative and Complementary Medicine, New York, v. 16, n. 4, p. 473-479, 2010.)	1	1	1	2	1	1	2	9
Aydin Avci; Koç; Saglam (2012)AYDIN AVCI, I.; KOÇ, Z.; SAĞLAM, Z. Use of complementary and alternative medicine by patients with cancer in northern Turkey: analysis of cost and satisfaction. Journal of clinical nursing, New Jersey, v. 21, n. 5-6, p. 677-688, 2012.	1	2	1	1	1	0	1	7
Chuang et al. (2012CHUANG, L.H. et al. A pragmatic multicentered randomized controlled trial of yoga for chronic low back pain: economic evaluation. Spine, Philadelphia, v. 37, n. 18, p. 1593-1601, 2012.)	2	2	2	2	2	2	2	14
Kooreman; Baars (2012KOOREMAN, P.; BAARS, E. W. Patients whose GP knows complementary medicine tend to have lower costs and live longer. The European Journal of Health Economics, Berlin, v. 13, n. 6, p. 769-776, 2012.)	2	1	2	1	2	1	1	10
Molassioti et al. (2013)MOLASSIOTIS, A. et al. The effectiveness and cost-effectiveness of acupressure for the control and management of chemotherapy-related acute and delayed nausea: Assessment of Nausea in Chemotherapy Research (ANCHoR), a randomised controlled trial. Health Technology Assessment, Winchester, v. 17, n. 26, p. 1, 2013.	2	1	2	2	2	2	2	13
Baars; Kooreman (2014BAARS, E. W.; KOOREMAN, P. A 6-year comparative economic evaluation of healthcare costs and mortality rates of Dutch patients from conventional and CAM GPs. BMJ Open, London, v. 4, n. 8, p. e005332, 2014.)	2	1	2	1	2	1	1	10
Leininger et al. (2016LEININGER, B. et al. Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain. Spine, Philadelphia, v. 16, n. 11, p. 1292-1304, 2016.)	2	2	2	2	2	2	2	14
Elder et al. (2018)	2	1	2	2	1	2	2	12
Herman et al. (2019HERMAN, P. M. et al. The use of complementary and integrative health approaches for chronic musculoskeletal pain in younger US Veterans: An economic evaluation. PLoS One, San Francisco, v. 14, n. 6, p. e0217831, 2019.)	2	1	2	2	2	1	2	12
Wayne et al. (2019WAYNE, P. M. et al. Cost-effectiveness of a team-based integrative medicine approach to the treatment of back pain. The Journal of Alternative and Complementary Medicine, New York, v. 25, n. S1, p. S138-S146, 2019.)	2	2	2	2	2	2	2	14
Kass et al. (2020KASS, B. et al. Effectiveness and cost-effectiveness of treatment with additional enrollment to a homeopathic integrated care contract in Germany. BMC health services research, London, v. 20, n. 1, p. 1-12, 2020.)	1	2	1	1	2	1	1	9
Pico-Espinosa et al. (2020PICO-ESPINOSA, O. J. et al. Deep tissue massage, strengthening and stretching exercises, and a combination of both compared with advice to stay active for subacute or persistent non-specific neck pain: A cost-effectiveness analysis of the Stockholm Neck trial (STONE). Musculoskeletal Science and Practice, Amsterdam, v. 46, p. 102109, 2020.)	2	2	2	2	2	2	2	14
Thronicke et al. (2020THRONICKE, A. et al. Cost-effectiveness of real-world administration of concomitant Viscum album L. therapy for the treatment of stage IV pancreatic cancer. Evidence-Based Complementary and Alternative Medicine, Oxford, v. 2020, p. 3543568, 2020.)	2	1	2	1	2	1	1	10
Park et al. (2021)	2	2	2	2	2	2	2	14

	Acupuntura/ Acupressão	Medicina Antroposófica	Terapia Manipulativa *	Plantas Medicinais	Homeopatia	Yoga	Práticas Variadas	Total, n (%)
Faixa etária da população
0-17 anos	-	-	-	-	1	-	1	2 (9)
18-65 anos	3	1	5	-	2	1	5	17 (77)
>65 anos	-	-	1	1	1	-	-	3 (14)
Condição crônica
Câncer	1	-	-	1	-	-	1	3 (14)
Dor musculo-esquelética	1	-	6	-	-	1	2	10 (47,5)
Doença respiratória	1	-	-	-	1	-	-	2 (9,5)
Depressão	-	1	-	-	-	-	-	1 (5)
Neuropatia diabética	-	-	-	-	1	-	-	1 (5)
Várias	-	-	-	-	1	-	3	4 (19)
Local da Intervenção
Ambulatório ou clínica	1	1	4	-	3	-	1	10 (48)
Hospital	2	-	1	1	-	-	3	7 (33)
Atenção Primária	-	-	1	-	-	1	-	2 (9,5)
Provedor Nacional de Saúde	-	-	-	-	-	-	2	2 (9,5)

	Acupuntura/ Acupressão		Medicina Antroposófica		Terapias Manipulativas *		Plantas Medicinais		Homeopatia		Yoga		Práticas Variadas		Total, n (%)
Tipo de Avaliação Econômica
Custo-efetividade	3		-		3		1		1		1		1		10 (47,5)
Custo-minimização	-		-		1		-		-		-		-		1 (5)
Custos e consequências	-		1		2		-		2		-		5		10 (47,5)
Perspectiva
Individual	-		-		-		-		1		-		2		3 (14)
Provedor	1		-		3		1		2		-		3		10 (45)
Societal	2		1		3		-		1		1		1		9 (41)
Custos Descritos
Inespecíficos	-		-		-		-		-		-		2		2 (3,5)
Procedimentos	3		1		6		1		2		1		4		18 (31,5)
Cuidado domiciliar	-		-		-		-		1		-				1 (2)
Medicamentos	3		-		5		-		3		-		4		15 (26)
Desembolso direto	-		-		2		-		2		1		-		5 (9)
Tempo do usuário	1		-		3		-		-		-		-		4 (7)
Deslocamento	1		-		2		-		1		-		-		4 (7)
Perda de produtividade	1		1		3		-		1		1		1		8 (14)
Resultados biológicos
Marcadores orgânicos		-		-		-		-		1		-		-	1 (2,5)
Escala de incapacidade		-		-		1		-		-		-		-	1 (2,5)
Mortalidade / sobrevida		-		-		-		1		-		-		2	3 (8)
Consumo de medicamentos		-		-		1		-		1		-		1	3 (8)
Efeitos colaterais		-		-		-		-		-		-		1	1 (2,5)
Sintomatologia clínica		1		1		4		-		3		-		2	11 (29)
Resultados humanísticos
Avaliação pelo usuário		1		-		2		-		-		-		2	5 (13)
Relação terapeuta- usuário		-		-		1		-		-		-		-	1 (2,5)
Resultados Globais
Qualidade de Vida / utilidade		2		1		5		-		2		1		1	12 (32)

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[1] Editora responsável: Tatiana Wargas