ArticleLiterature Review

Economic evaluations of homeopathy: A review

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Abstract

Context Economic evaluations of commonly used complementary and alternative medicine (CAM) therapies such as homeopathy are needed to contribute to the evidence base on which policy makers, clinicians, health-care payers, as well as patients base their health-care decisions in an era of constrained resources. Objectives To review and assess existing economic evaluations of homeopathy. Methods Literature search was made to retrieve relevant publications using AMED, the Cochrane Library, CRD (DARE, NHS EED, HTA), EMBASE, MEDLINE, and the journal Homeopathy (former British Homoeopathic Journal). A hand search of relevant publications was carried out. Homeopathy researchers were contacted. Identified publications were independently assessed by two authors. Results Fifteen relevant articles reported on 14 economic evaluations of homeopathy. Thirteen studies reported numbers of patients: a total of 3,500 patients received homeopathic treatment (median 97, interquartile range 48–268), and 10 studies reported on control group participants (median 57, IQR 40–362). Eight out of 14 studies found improvements in patients’ health together with cost savings. Four studies found that improvements in homeopathy patients were at least as good as in control group patients, at comparable costs. Two studies found improvements similar to conventional treatment, but at higher costs. Studies were highly heterogeneous and had several methodological weaknesses. Conclusions Although the identified evidence of the costs and potential benefits of homeopathy seemed promising, studies were highly heterogeneous and had several methodological weaknesses. It is therefore not possible to draw firm conclusions based on existing economic evaluations of homeopathy. Recommendations for future research are presented.

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... Conclusions about the effectiveness and cost-effectiveness were impossible to draw from these analyses since the effectiveness was not measured. The latest systematic review, which included 14 studies regarding the cost-effectiveness of homeopathic treatment, showed methodological weaknesses in combination with heterogeneous studies and resulted in the inability of the authors to reveal "any firm conclusions about the cost-effectiveness of homeopathy based on the existing evidence" [10]. Another problem was the relatively small sample sizes of the included studies, which has occurred in previous studies as well [11,12]. ...
... No specific strategies for outlier handling were used, since the underlying cost data showed no hint for extreme outliers. Because the primary outcome was defined a priori, no adjustment for multiple testing was conducted [10]. The secondary analyses were explorative; therefore, the results for secondary outcomes are judged in an exploratory manner. ...
... For example, the systematic review by Viksveen et al. regarding the cost-effectiveness of homeopathic treatment identified 14 studies. While eight studies reported improved effects combined with cost savings, four studies showed similar or improved outcomes at the same costs, and two studies showed similar effects combined with higher costs from the homeopathic perspective [10]. However, most studies were small and had methodological limitations. ...
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Background: A number of German statutory health insurance companies are offering integrated care contracts for homeopathy (ICCHs) that cover the reimbursement of homeopathic treatment. The effectiveness and cost-effectiveness of these contracts are highly debated. Methods: To evaluate the effectiveness and cost-effectiveness of treatment after an additional enrollment in an ICCH, a comparative, prospective, observational study was conducted in which participants in the ICCH (HOM group) were compared with matched (on diagnosis, sex and age) insured individuals (CON group) who received usual care alone. Those insured with either migraine or headache, allergic rhinitis, asthma, atopic dermatitis and depression were included. Primary effectiveness outcomes were the baseline adjusted scores of diagnosis-specific questionnaires (e.g. RQLQ, AQLQ, DLQI, BDI-II) after 6 months. Primary cost-effectiveness endpoints were the baseline adjusted total costs from an insurer perspective in relation to the achieved quality-adjusted life years (QALYs). Costs were derived from health claims data and QALYs were calculated based on SF-12 data. Results: Data from 2524 participants (1543 HOM group) were analyzed. The primary effectiveness outcomes after six months were statistically significant in favor of the HOM group for migraine or headache (Δ = difference between groups, days with headache: - 0.9, p = 0.042), asthma (Δ-AQLQ(S): + 0.4, p = 0.014), atopic dermatitis (Δ-DLQI: - 5.6, p ≤ 0.001) and depression (Δ-BDI-II: - 5.6, p ≤ 0.001). BDI-II differences reached the minimal clinically important difference. For all diagnoses, the adjusted mean total costs over 12 months were higher in the HOM group from an insurer perspective, with migraine or headache, atopic dermatitis and depression suggesting cost-effectiveness in terms of additional costs per QALY gained. Conclusion: After an additional enrollment in the ICCH, the treatment of participants with depression showed minimally clinically relevant improvements. From an insurer perspective, treatment with an ICCH enrollment resulted in higher costs over all diagnoses but seemed to be cost-effective for migraine or headache, atopic dermatitis and depression according to international used threshold values. Based on the study design and further limitations, our findings should be considered cautiously and no conclusions regarding the effectiveness of specific treatment components can be made. Further research is needed to overcome limitations of this study and to confirm our findings. Trial registration: clinicaltrials.gov , NCT01854580. Registered 15 March 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01854580.
... Substances may be diluted up to a concentration in which no molecule of the original substance can be found in the dilution [6]. Apart from Germany, homeopathy is popular among many people around the globe, especially in Europe [7]. Its popularity stems, among other causes, from the often extensive consultation time that homeopathic physicians provide, the absence of adverse effects and the belief in its effects [8,9]. ...
... A recent systematic review that summarized the available literature on cost-effectiveness provided no distinct conclusion [7]. Homeopathy is reimbursed by German statutory health insurance companies within the context of integrated care contracts [11], and patients can be enrolled in integrated care contracts by their physicians. ...
... A recent systematic review by Viksveen on the cost-effectiveness of homeopathy showed that in eight out of fourteen studies, the homeopathic treatment was less cost-intensive than the conventional treatment; in four studies, the treatment costs were similar; and in two studies, the homeopathic treatment was more costly than conventional treatment [7]. However, the review also indicated that the included economic evaluations of homeopathy were heterogeneous and lacked methodological quality. ...
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Objectives: The aim of this study was to compare the health care costs for patients using additional homeopathic treatment (homeopathy group) with the costs for those receiving usual care (control group). Methods: Cost data provided by a large German statutory health insurance company were retrospectively analysed from the societal perspective (primary outcome) and from the statutory health insurance perspective. Patients in both groups were matched using a propensity score matching procedure based on socio-demographic variables as well as costs, number of hospital stays and sick leave days in the previous 12 months. Total cumulative costs over 18 months were compared between the groups with an analysis of covariance (adjusted for baseline costs) across diagnoses and for six specific diagnoses (depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache). Results: Data from 44,550 patients (67.3% females) were available for analysis. From the societal perspective, total costs after 18 months were higher in the homeopathy group (adj. mean: EUR 7,207.72 [95% CI 7,001.14-7,414.29]) than in the control group (EUR 5,857.56 [5,650.98-6,064.13]; p<0.0001) with the largest differences between groups for productivity loss (homeopathy EUR 3,698.00 [3,586.48-3,809.53] vs. control EUR 3,092.84 [2,981.31-3,204.37]) and outpatient care costs (homeopathy EUR 1,088.25 [1,073.90-1,102.59] vs. control EUR 867.87 [853.52-882.21]). Group differences decreased over time. For all diagnoses, costs were higher in the homeopathy group than in the control group, although this difference was not always statistically significant. Conclusion: Compared with usual care, additional homeopathic treatment was associated with significantly higher costs. These analyses did not confirm previously observed cost savings resulting from the use of homeopathy in the health care system.
... Costs incurred for conducting ineffective procedures are always too high. A comprehensive systematic review for the cost effectiveness of CAM procedures, which also considered the design of the underlying effectiveness studies, found mostly additional costs and cost reductions in about 30% of the studies; in this regard, reference was made to the substantial heterogeneity of the quality of studies, as in other reviews [150], [151]. ...
... Kosten, die für die Durchführung unwirksamer Verfahren aufgewendet werden, sind immer zu hoch. Ein umfassender systematischer Review zur Kosten-Effektivität von CAM-Verfahren, der auch das Design der unterliegenden Effektivitätsstudien beachtete, fand meist zusätzliche Kosten und in etwa 30% der Studien Kostenreduktionen; dabei wurde -wie in anderen Reviews -auf substanzielle Heterogenität der Studienqualität verwiesen [150], [151]. CAM-Verfahren ohne Berücksichtigung ihrer Wirksamkeit zu integrieren, weil sie preiswerter sind als die wissenschaftlich orientierte Medizin und diese Einführung daher entweder nicht sehr ins Gewicht falle oder zu Einsparungen führen könne, entspricht nicht den sozialrechtlichen und ethischen Anforderungen an die medizinische Versorgung. ...
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This opinion deals critically with the so-called complementary and alternative medical (CAM) therapy on the basis of current data. From the authors’ perspective, CAM prescriptions and most notably the extensive current endeavours to the “integration” of CAM into conventional patient care is problematic in several respects. Thus, several CAM measures are used, although no specific effects of medicines can be proved in clinical studies. It is extensively explained that the methods used in this regard are those of evidence-based medicine, which is one of the indispensable pillars of science-oriented medicine. This standard of proof of efficacy is fundamentally independent of the requirement of being able to explain efficacy of a therapy in a manner compatible with the insights of the natural sciences, which is also essential for medical progress. Numerous CAM treatments can however never conceivably satisfy this requirement; rather they are justified with pre-scientific or unscientific paradigms. The high attractiveness of CAM measures evidenced in patients and many doctors is based on a combination of positive expectations and experiences, among other things, which are at times unjustified, at times thoroughly justified, from a science-oriented view, but which are non-specific (context effects). With a view to the latter phenomenon, the authors consider the conscious use of CAM as unrevealed therapeutic placebos to be problematic. In addition, they advocate that academic medicine should again systematically endeavour to pay more attention to medical empathy and use context effects in the service of patients to the utmost. The subsequent opinion discusses the following after an introduction to medical history: the definition of CAM; the efficacy of most common CAM procedures; CAM utilisation and costs in Germany; characteristics of science-oriented medicine; awareness of placebo research; pro and contra arguments about the use of CAM, not least of all in terms of aspects related to medical ethics.
... Research efforts should focus on conducting high-quality studies to elucidate homeopathy's mechanisms of action, identify patient subgroups most likely to benefit, and determine its comparative effectiveness against conventional treatments. (17)(18)(19) Economic analyses should evaluate the cost-effectiveness of incorporating homeopathy into healthcare systems, accounting for potential savings, as well as the opportunity costs associated with allocating resources to unproven interventions. Policy decisions should be informed by scientific evidence, guided by principles of patient safety and autonomy, and responsive to public preferences and values. ...
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Background: In contemporary healthcare, evidence-based practices are fundamental for ensuring optimal patient outcomes and resource allocation. Essential steps for conducting pharmacoeconomic studies in homeopathy involve study design, intervention identification, comparator selection, outcome measures definition, data collection, cost analysis, effectiveness analysis, cost-effectiveness analysis, cost-benefit analysis, sensitivity analysis, reporting, and peer review. While conventional medicine undergoes rigorous pharmacoeconomic evaluations, the field of homeopathy often lacks such scrutiny. However, the importance of pharmacoeconomic studies in homeopathy is increasingly recognized, given its growing integration into modern healthcare systems. Methods: A systematic search of electronic databases (PubMed, Scopus, Web of Science) was performed to identify relevant literature using keywords such as "homeopathy," "pharmacoeconomics," and "efficacy." Articles meeting inclusion criteria were assessed for quality using established frameworks like the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Data synthesis was conducted thematically, focusing on study objectives, methodologies, findings, and conclusions. Results: Ten pharmacoeconomic studies within homeopathy were identified, demonstrating varying degrees of compliance with reporting guidelines. While most studies reported costs comprehensively, some lacked methodological transparency, particularly in analytic methods. Heterogeneity was observed in study designs and outcome measures, reflecting the complexity of economic evaluation in homeopathy. Quality of evidence varied, with some studies exhibiting robust methodologies while others had limitations. Conclusion: Based on the review, recommendations include promoting homeopathic clinics, providing policy support, adopting collaborative healthcare models, and leveraging India's homeopathic resources. Pharmacoeconomic studies in homeopathy are crucial for evaluating its economic implications compared to conventional medicine. While certain studies demonstrated methodological rigor, opportunities exist for enhancing consistency, transparency, and quality in economic evaluations. Addressing these challenges is essential for informing decision-making regarding the economic aspects of homeopathic interventions
... Studies indicate potential costeffectiveness and even cost savings across a number of CAM therapies. Within the AYUSH system of medicine, there are fifteen economic evaluation studies on homeopathy (18), and a promising number of quality studies in yoga have been published (19;20). However, there are no economic evaluation studies on ayurveda, siddha, and unani in the literature. ...
Article
The double burden of communicable and noncommunicable diseases is a major threat to the Indian public health system. AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa, and Homeopathy, represents the Indian system of medicine recognized by the Government of India. Mainstreaming of AYUSH is one of the key strategies of the Indian government for tackling increasing disease burden through initiatives such as AYUSH wellness centers, telemedicine, and quality control measures for medications in the AYUSH system of medicine. Such investment of resources in health systems may require economic evaluations. However, such evaluations are lacking in the AYUSH system, except for a few in homeopathy and yoga. In the absence of evidence from economic evaluations, researchers and decision makers are guided mostly by clinical efficacy while formulating healthcare strategies. In view of the increasing use of AYUSH across the country, economic evaluations of the AYUSH system are the need of the hour to aid healthcare decision making.
... A study evaluated cost effectiveness of homeopathy plus usual care in comparison with usual care in children requiring secondary care for asthma and national healthcare costs were significantly higher in the homeopathy group [28]. However, recent review of the economic evaluations of homeopathy concluded that variability and limitations in methodology had a significant impact on their ability to interpret these studies, although the identified evidence of the cost seemed promising [31]. A lower cost of care can also make these therapies attractive but first of all beneficial effects have to be established before such calculations can be performed. ...
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Background Asthma is a common chronic disease worldwide without any known cure. Despite remarkable improvement in asthma treatment, better education and guideline implementation strategies, there is growing interest in using complementary and alternative medicine, like reflexology and homeopathy. However, evidence supporting the effectiveness of homeopathy and reflexology in asthma treatment is not available. Objective The aim of this study was to evaluate the effect of reflexology and homeopathy as adjunctive therapies in asthma. Methods In a single centre, randomised, investigator blinded, controlled study 86 asthma patients were enrolled. They were assigned to one of three study groups (conventional treatment alone or conventional treatment with addition of either homeopathy or reflexology). All patients received their asthma treatment during the study and were followed as usual by their general practitioner. The study assignment group of individual patients were blinded to the investigators, who made the clinical evaluation of asthma control. The primary outcome was the change in the asthma quality of life questionnaire (AQLQ) scores after 26 weeks. Secondary outcomes included asthma control questionnaire, EuroQol, forced expiratory volume in 1 sec, morning and evening peak expiratory flow, asthma symptoms, rescue medication use, and total medication score. Results Minor improvements in the AQLQ score were observed in all three groups. However, no statistically significant changes in AQLQ scores were seen within or between groups. Likewise, secondary outcomes did not differ between groups. Conclusions In this study, the addition of homeopathy or reflexology to conventional treatment did not result in improved quality of life in asthma.
... Observational studies under real-world medical conditions have shown that homeopaths and other CAM health practitioners yield effects comparable to conventional therapists but with less conventional drug exposure and often at less cost. 56 Those "non-specific effects" are still a Give the source of funding and the role of the funders for the present study and, if applicable, for the original study on which the present article is based a Give information separately for cases and controls in case-control studies and, if applicable, for exposed and unexposed groups in cohort and crosssectional studies. ...
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Background Randomized placebo-controlled trials are considered to be the gold standard in clinical research and have the highest importance in the hierarchical system of evidence-based medicine. However, from the viewpoint of decision makers, due to lower external validity, practical results of efficacy research are often not in line with the huge investments made over decades. Method We conducted a narrative review. With a special focus on homeopathy, we give an overview on cohort, comparative cohort, case-control and cross-sectional study designs and explain guidelines and tools that help to improve the quality of observational studies, such as the STROBE Statement, RECORD, GRACE and ENCePP Guide. Results Within the conventional medical research field, two types of arguments have been employed in favor of observational studies. First, observational studies allow for a more generalizable and robust estimation of effects in clinical practice, and if cohorts are large enough, there is no over-estimation of effect sizes, as is often feared. We argue that observational research is needed to balance the current over-emphasis on internal validity at the expense of external validity. Thus, observational research can be considered an important research tool to describe “real-world” care settings and can assist with the design and inform the results of randomised controlled trails. Conclusions We present recommendations for designing, conducting and reporting observational studies in homeopathy and provide recommendations to complement the STROBE Statement for homeopathic observational studies.
... When it was asked that the price of homeopathic products is less than the allopathic medicines, DHMS was strongly agreed while BHMS was neutrally agreed. It is indicated by evidences that the price of homeopathic medicines are relatively less, as compared to allopathic medicines (24) and homeopathy improves health with cost saving (25) . Furthermore on the question of affordability of homeopathic medicine, DHMS was strongly agreed that they can afford homeopathic products because of its low prices. ...
Article
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The objective of this study was to assess homeopathic student's perception and attitude about effectiveness and price of homeopathic products. An institutional survey was carried out in Pakistan homeopathic medical college, hospital and research center among undergraduate homeopathic students. Total 65 students participated in this study and a pretested questionnaire was filled by all students. Students were asked to rate their answers on a Likert scale. 29 students from BHMS department (7 male, 22 female) and 36 students (6 male, 30 female) from DHMS department were participated in this survey. After compiling the answers of respondents we observed that BHMS and DHMS had same point of view on some aspects while contradictions on others aspects. When respondents were asked that all homeopathic products are effective in treating the disease, DHMS students were strongly agreed and many BHMS students were just agreed on it while some not agree on it. When the respondents were asked that is cost of homeopathic products are less than the allopathic products than DHMS students were strongly agreed while BHMS students were neutral. Major findings of this study were that, homeopathic students have positive approach towards complementary and alternative medicine. Both BHMS and DHMS have the same opinion that further scientific testing should be done in homeopathy for its further acceptance. They supported the efficacy of homeopathy with least side effects and adverse reactions. Both groups were in favor of effectiveness of homeopathy in almost every disease.
... The evidence from economic evaluations of homeopathy is inconclusive: whereas some studies have shown that it offers cost-saving potential [13][14][15], other evaluations have shown it to be either more expensive [16][17][18] or to have similar costs [19] as usual care. A recent review by Viksveen concluded that the methodologies used in current studies are often weak and that it is therefore impossible to derive unequivocal conclusions from cost evaluations of homeopathy [20]. Our previous analyses of the integrated care contract 'homeopathy' showed that the cumulative costs of patients using homeopathic treatment in addition to usual care over an 18-month period were higher than the costs of patients using only usual care. ...
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Objectives This study aimed to provide a long-term cost comparison of patients using additional homeopathic treatment (homeopathy group) with patients using usual care (control group) over an observation period of 33 months. Methods Health claims data from a large statutory health insurance company were analysed from both the societal perspective (primary outcome) and from the statutory health insurance perspective (secondary outcome). To compare costs between patient groups, homeopathy and control patients were matched in a 1:1 ratio using propensity scores. Predictor variables for the propensity scores included health care costs and both medical and demographic variables. Health care costs were analysed using an analysis of covariance, adjusted for baseline costs, between groups both across diagnoses and for specific diagnoses over a period of 33 months. Specific diagnoses included depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache. Results Data from 21,939 patients in the homeopathy group (67.4% females) and 21,861 patients in the control group (67.2% females) were analysed. Health care costs over the 33 months were 12,414 EUR [95% CI 12,022–12,805] in the homeopathy group and 10,428 EUR [95% CI 10,036–10,820] in the control group (p<0.0001). The largest cost differences were attributed to productivity losses (homeopathy: EUR 6,289 [6,118–6,460]; control: EUR 5,498 [5,326–5,670], p<0.0001) and outpatient costs (homeopathy: EUR 1,794 [1,770–1,818]; control: EUR 1,438 [1,414–1,462], p<0.0001). Although the costs of the two groups converged over time, cost differences remained over the full 33 months. For all diagnoses, homeopathy patients generated higher costs than control patients. Conclusion The analysis showed that even when following-up over 33 months, there were still cost differences between groups, with higher costs in the homeopathy group.
... The evaluation of medical practices that prescribe homeopathic medicines is particularly important for public-health policy makers as it may have a considerable impact on healthcare costs. Although there have been many studies on the cost-efficacy of homeopathic or nonconventional treatments compared to other medical treatments [4][5][6][7][8], relatively few studies have analysed the actual costs of primary care to the Social Security Agency (l' Assurance Maladie), supplementary health insurance and the patient. In France, knowledge of the management of morbidity in hospitals has increased with the establishment of the PMSI (Programme de médicalisation des sytèmes d'information). ...
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Health authorities are constantly searching for new ways to stabilise health expenditures. To explore this issue, we compared the costs generated by different types of medical practice in French general medicine: i.e. conventional (CM-GP), homeopathic (Ho-GP), or mixed (Mx-GP). Data from a previous cross-sectional study, EPI3 La-Ser, were used. Three types of cost were analysed: (i) consultation cost (ii) prescription cost and (iii) total cost (consultation + prescription). Each was evaluated as: (i) the cost to Social Security (ii) the remaining cost (to the patient and/or supplementary health insurance); and (iii) health expenditure (combination of the two costs). With regard to Social Security, treatment by Ho-GPs was less costly (42.00 € vs 65.25 € for CM-GPs, 35 % less). Medical prescriptions were two-times more expensive for CM-GPs patients (48.68 € vs 25.62 €). For the supplementary health insurance and/or patient out-of-pocket costs, treatment by CM-GPs was less expensive due to the lower consultation costs (6.19 € vs 11.20 € for Ho-GPs) whereas the prescription cost was comparable between the Ho-GPs and the CM-GPs patients (15.87 € vs 15.24 € respectively) . The health expenditure cost was 20 % less for patients consulting Ho-GPs compared to CM-GPs (68.93 € vs 86.63 €, respectively). The lower cost of medical prescriptions for Ho-GPs patients compared to CM-GPs patients (41.67 € vs 63.72 €) was offset by the higher consultation costs (27.08 € vs 22.68 € respectively). Ho-GPs prescribed fewer psychotropic drugs, antibiotics and non-steroidal anti-inflammatory drugs. In conclusions management of patients by homeopathic GPs may be less expensive from a global perspective and may represent an important interest to public health.
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Medical pluralism, a phenomenon wherein individuals engage with multiple healthcare systems and healing practices, has become an increasingly important area of research within the field of medical anthropology and public health. This research provides an overview of the current state of knowledge in the realm of medical pluralism, highlighting the need for a multidisciplinary approach to better understand its implications on healthcare delivery and outcomes. Medical pluralism is a complex and dynamic interplay of diverse medical systems, such as traditional medicine, complementary and alternative medicine (CAM), and biomedicine, that individuals utilize to address their health needs. The key themes within medical pluralism research, including the cultural, social, and economic factors influencing the choice of healthcare systems, the challenges and opportunities for healthcare integration and collaboration, and the impact of medical pluralism on health disparities and patient outcomes. Furthermore, the abstract emphasizes the importance of bridging the gap between conventional biomedical healthcare and traditional or alternative healing practices. By understanding the diverse ways individuals seek health and healing, researchers and healthcare providers can develop more inclusive and effective healthcare strategies that are sensitive to cultural differences and individual preferences. Additionally, exploring the safety and efficacy of various complementary and alternative therapies within the context of medical pluralism is crucial to ensuring the well-being of patients. The growing significance of medical pluralism in the modern healthcare landscape encourages further research and collaboration between medical anthropologists, healthcare providers, and policymakers. A comprehensive understanding of medical pluralism will aid in the development of healthcare systems that respect and accommodate the diverse healthcare choices of individuals, ultimately leading to more equitable and patient-centered care.
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Introduction: Likewise other medical interventions, economic evaluations of homeopathy contribute to the evidence base of therapeutic concepts and are needed for socioeconomic decision-making. A 2013 review was updated and extended to gain a current overview. Methods: A systematic literature search of the terms 'cost' and 'homeopathy' from January 2012 to July 2022 was performed in electronic databases. Two independent reviewers checked records, extracted data, and assessed study quality using the Consensus on Health Economic Criteria (CHEC) list. Results: Six studies were added to 15 from the previous review. Synthesizing both health outcomes and costs showed homeopathic treatment being at least equally effective for less or similar costs than control in 14 of 21 studies. Three found improved outcomes at higher costs, two of which showed cost-effectiveness for homeopathy by incremental analysis. One found similar results and three similar outcomes at higher costs for homeopathy. CHEC values ranged between two and 16, with studies before 2009 having lower values (Mean ± SD: 6.7 ± 3.4) than newer studies (9.4 ± 4.3). Conclusion: Although results of the CHEC assessment show a positive chronological development, the favorable cost-effectiveness of homeopathic treatments seen in a small number of high-quality studies is undercut by too many examples of methodologically poor research.
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In this article we attempt to put forth insights into using traditional medicine (TM) systems to achieve Universal Health Coverage (UHC). We discuss the need for reimagining India's health system and the importance of an inclusive approach for UHC. We comprehend the challenges with appropriate use of TM systems and the lessons from international experience of integrating TM systems. We highlight the pathways for better utilization of TM systems for UHC in India.
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Homeopathy is used by just over 2% of the U.S. population, predominantly for respiratory, otorhinolaryngology, and musculoskeletal complaints. Individual users who see a homeopathic provider for care are more likely to perceive the therapy as helpful than those who do not; however, only 19% of users in the United States see a provider. The rest presumably rely upon over-the-counter products. Recent clinical trials highlight several areas in which homeopathy may play a role in improving public health, including infectious diseases, pain management, mental health, and cancer care. This review examines recent studies in these fields, studies assessing costs associated with homeopathic care, safety, and regulations in the United States. Data suggest the potential for public health benefit from homeopathy, especially for conditions such as upper respiratory infections and fibromyalgia.
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This report on the current state of homeopathic research provides a summary on the research areas of healthcare research, randomised controlled clinical trials, meta-analyses and basic research. It aims to contribute to the discussion within the field of homeopathy concerning the need for research, the relevance of individual research fields and methods and their role in future research strategies. A summary analysis of the clinical research data offers sufficient evidence of the therapeutic effectiveness of homeopathic treatment. The results from numerous placebo-controlled trials and basic research experiments suggest, moreover, that potentised medicines offer specific efficacy. Put in perspective, there are many important open research areas – notably: Basic research into the optimisation of laboratory models and the understanding of the mode of action, Independent replications of studies in clinical and basic research, Exploration of the provision of homeopathic care in reality, also combined with conventional medicine and Health economic analyses to evaluate the costs and benefits (cost effectiveness).
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Introduction Recent Belgian legislation generated the need for homeopathic training of midwives. The Centre of Classical Homeopathy (CKH) offered a 50-hours course in homeopathy as a pilot project within the Continuing Professional Development (CPD) program of Thomas More College. Methods The curriculum was designed to combine a minimum of homeopathic philosophical underpinning with appropriate clinical exercises within the limited training hours available. Eight participants followed the course. Evaluation of the course followed in the last session through a self-completed questionnaire with closed questions on course content and transfer to practice and open questions on didactics and the organisation of the course. Recommendations for the future were also queried. Results Although the learning objectives were met, participants provided useful feedback regarding content and method for the future organisation of the course. They felt more topics should be included such as, the postpartum period. They suggested supplementing the material from the current training with more practice and cases, and expanding the course to a full year’s training, allowing more time between sessions for processing the material. To use homeopathy for acute prescribing, more training on repertorisation techniques and materia medica knowledge would be required. Conclusions Training midwives in homeopathy requires considerably more time than the 50 contact hours stipulated by law and would best be offered as interactive sessions providing powerful concrete case examples, spread over the course of one full year to allow for integration of the material into practice.
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This highly successful textbook is now available in its third edition. Over the years it has become the standard textbook in the field world-wide. It mirrors the huge expansion of the field of economic evaluation in health care, since the last edition was published in 1997. This new edition builds on the strengths of previous editions, being clearly written in a style accessible to a wide readership. Key methodological principles are outlined using a critical appraisal checklist that can be applied to any published study. The methodological features of the basic forms of analysis are then explained in more detail with special emphasis of the latest views on productivity costs, the characterisation of uncertainty and the concept of net benefit. The book has been greatly revised and expanded especially concerning analysing patient-level data and decision-analytic modelling. There is discussion of new methodological approaches, including cost effectiveness acceptability curves, net benefit regression, probalistic sensitivity analysis and value of information analysis. There is an expanded chapter on the use of economic evaluation, including discussion of the use of cost-effectiveness thresholds, equity considerations and the transferability of economic data. This new edition is required reading for anyone commissioning, undertaking or using economic evaluations in health care, and will be popular with health service professionals, health economists, pharmacand health care decision makers. It is especially relevant for those taking pharmacoeconomics courses.
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Growing levels of both obesity and chronic disease in the general population pose a major public health problem. In the UK, an innovative 'health and weight' cohort trials facility, the 'South Yorkshire Cohort', is being built in order to provide robust evidence to inform policy, commissioning and clinical decisions in this field. This protocol reports the design of the facility and outlines the recruitment phase methods. The South Yorkshire Cohort health and weight study uses the cohort multiple randomised controlled trial design. This design recruits a large observational cohort of patients with the condition(s) of interest which then provides a facility for multiple randomised controlled trials (with large representative samples of participants, long term outcomes as standard, increased comparability between each trial conducted within the cohort and increased efficiency particularly for trials of expensive interventions) as well as ongoing information as to the natural history of the condition and treatment as usual.This study aims to recruit 20,000 participants to the population based South Yorkshire Cohort health and weight research trials facility. Participants are recruited by invitation letters from their General Practitioners. Data is collected using postal and/or online patient self completed Health Questionnaires. NHS numbers will be used to facilitate record linkage and access to routine data. Participants are eligible if they are: aged 16 - 85 years, registered with one of 40 practices in South Yorkshire, provide consent for further contact from the researchers and to have their information used to look at the benefit of health treatments. The first wave of data is being collected during 2010/12 and further waves are planned at 2 - 5 year intervals for the planned 20 year duration of the facility. The South Yorkshire Cohort combines the strengths of the standard observational, longitudinal cohort study design with a population based cohort facility for multiple randomised controlled trials in a range of long term health and weight related conditions (including obesity). This infrastructure will allow the rapid and cheap identification and recruitment of patients, and facilitate the provision of robust evidence to inform the management and self-management of health and weight.
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Background: Health economists have largely ignored complementary and alternative medicine (CAM) as an area of research, although both clinical experiences and several empirical studies suggest cost-effectiveness of CAM. Objective: To explore the cost-effectiveness of CAM compared with conventional medicine. Methods: A dataset from a Dutch health insurer was used containing quarterly information on healthcare costs (care by general practitioner (GP), hospital care, pharmaceutical care, and paramedic care), dates of birth and death, gender and 6-digit postcode of all approximately 150,000 insurees, for the years 2006-2009. Data from 1913 conventional GPs were compared with data from 79 GPs with additional CAM training in acupuncture (25), homeopathy (28), and anthroposophic medicine (26). Results: Patients whose GP has additional CAM training have 0-30% lower healthcare costs and mortality rates, depending on age groups and type of CAM. The lower costs result from fewer hospital stays and fewer prescription drugs. Discussion: Since the differences are obtained while controlling for confounders including neighborhood specific fixed effects at a highly detailed level, the lower costs and longer lives are unlikely to be related to differences in socioeconomic status. Possible explanations include selection (e.g. people with a low taste for medical interventions might be more likely to choose CAM) and better practices (e.g. less overtreatment, more focus on preventive and curative health promotion) by GPs with knowledge of complementary medicine. More controlled studies (replication studies, research based on more comprehensive data, cost-effectiveness studies on CAM for specific diagnostic categories) are indicated.
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Background Sinfrontal®, a complex homeopathic medication, is popular in Germany for the treatment of ear, nose and throat and respiratory tract infections. Unlike many other homeopathic or herbal medications, the efficacy and safety of Sinfrontal® has been demonstrated in a number of clinical studies of patients with sinusitis. Objective To assess the cost effectiveness of Sinfrontal® versus placebo in the treatment of adults with acute maxillary sinusitis (AMS) in Germany. A secondary objective was to assess the cost effectiveness of Sinfrontal® versus standard treatment with antibacterials. Methods Sinfrontal® was compared with placebo in a cost-utility analysis based on data from a randomized controlled clinical trial over 3 weeks (Sinfrontal® group: n=57; placebo group: n = 56). Trial data were analysed from a societal perspective; resource use was valued with German unit costs for 2005. In a secondary analysis, the longer-term cost utility of Sinfrontal® versus placebo was estimated over a total of 11 weeks based on an 8-week post-treatment observational phase. In addition, the cost effectiveness of Sinfrontal® versus antibacterials was determined based on an indirect comparison of placebo-controlled trials. Results Sinfrontal® led to incremental savings of €275 (95% CI 433, 103) per patient compared with placebo over 22 days, essentially due to the markedly reduced absenteeism from work (7.83 vs 12.9 workdays). Incremental utility amounted to 0.0087 QALYs (95% CI 0.0052, 0.0123), or 3.2 quality-adjusted life-days (QALDs). Bootstrapping showed that these findings were significant, with Sinfrontal® being dominant in 99.9% of simulations. The results were robust to a number of sensitivity analyses. In the secondary analysis, Sinfrontal® led to incremental cost savings of €511 and utility gains of 0.015 QALYs or 5.4 QALDs compared with placebo. Compared with antibacterials, Sinfrontal® had a significantly higher cure rate (11% vs 59%; p < 0.001) at similar or lower costs. Conclusion The results of this economic evaluation indicate that Sinfrontal® may be a cost-effective treatment for AMS in adults.
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The cmRCT design appears to be a workable and useful approach to pragmatic research questions that aim to inform healthcare decisions within routine practice. The design is best suited to circumstances that require open (rather than blinded) trials where "treatment as usual" is compared with the offer of study treatment, and to questions with outcomes that can be easily measured in the whole cohort (for example, patient reported outcomes). Clinical conditions where many clinical trials will be conducted and trials of desirable or expensive interventions are also well suited to the cmRCT approach. There are challenges to the cmRCT design. Further research is required to address a range of analysis and implementation questions related to the design and the ethics of patient centred informed consent for pragmatic randomised controlled trials. In his Harveian oration at the Royal College of Physicians, London, Professor Michael Rawlins, chair of the National Institute for Health and Clinical Excellence, called for "investigators to continue to develop and improve their methodologies in order to help decision makers appraise the evidence."22 We hope that the cmRCT design goes some way towards addressing the problems associated with existing approaches. If these problems are addressed, then perhaps the most important problem of all will be resolved-the non-implementation of the results of clinical research.
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Full-text available
Sinfrontal, a complex homeopathic medication, is popular in Germany for the treatment of ear, nose and throat and respiratory tract infections. Unlike many other homeopathic or herbal medications, the efficacy and safety of Sinfrontal has been demonstrated in a number of clinical studies of patients with sinusitis. To assess the cost effectiveness of Sinfrontal versus placebo in the treatment of adults with acute maxillary sinusitis (AMS) in Germany. A secondary objective was to assess the cost effectiveness of Sinfrontal versus standard treatment with antibacterials. Sinfrontal was compared with placebo in a cost-utility analysis based on data from a randomized controlled clinical trial over 3 weeks (Sinfrontal group: n = 57; placebo group: n = 56). Trial data were analysed from a societal perspective; resource use was valued with German unit costs for 2005. In a secondary analysis, the longer-term cost utility of Sinfrontal versus placebo was estimated over a total of 11 weeks based on an 8-week post-treatment observational phase. In addition, the cost effectiveness of Sinfrontal versus antibacterials was determined based on an indirect comparison of placebo-controlled trials. Sinfrontal led to incremental savings of euro 275 (95% CI 433, 103) per patient compared with placebo over 22 days, essentially due to the markedly reduced absenteeism from work (7.83 vs 12.9 workdays). Incremental utility amounted to 0.0087 QALYs (95% CI 0.0052, 0.0123), or 3.2 quality-adjusted life-days (QALDs). Bootstrapping showed that these findings were significant, with Sinfrontal being dominant in 99.9% of simulations. The results were robust to a number of sensitivity analyses. In the secondary analysis, Sinfrontal led to incremental cost savings of euro 511 and utility gains of 0.015 QALYs or 5.4 QALDs compared with placebo. Compared with antibacterials, Sinfrontal had a significantly higher cure rate (11% vs 59%; p < 0.001) at similar or lower costs. The results of this economic evaluation indicate that Sinfrontal may be a cost-effective treatment for AMS in adults.
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Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with homeopathy. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of homeopathy; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively. Eighteen out of 22 potentially relevant reviews preselected in the screening process met the inclusion criteria. Six reviews addressed the question whether homeopathy is effective across conditions and interventions. The majority of available trials seem to report positive results but the evidence is not convincing. For isopathic nosodes for allergic conditions, oscillococcinum for influenza-like syndromes and galphimia for pollinosis the evidence is promising while in other areas reviewed the results are equivocal. Reviews on homeopathy often address general questions. While the evidence is promising for some topics the findings of the available reviews are unlikely to end the controversy on this therapy.
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Out-of-pocket expenditures of over 34 billion dollars per year in the US are an apparent testament to a widely held belief that complementary and alternative medicine (CAM) therapies have benefits that outweigh their costs. However, regardless of public opinion, there is often little more than anecdotal evidence on the health and economic implications of CAM therapies. The objectives of this study are to present an overview of economic evaluation and to expand upon a previous review to examine the current scope and quality of CAM economic evaluations. The data sources used were Medline, AMED, Alt-HealthWatch, and the Complementary and Alternative Medicine Citation Index; January 1999 to October 2004. Papers that reported original data on specific CAM therapies from any form of standard economic analysis were included. Full economic evaluations were subjected to two types of quality review. The first was a 35-item checklist for reporting quality, and the second was a set of four criteria for study quality (randomization, prospective collection of economic data, comparison to usual care, and no blinding). A total of 56 economic evaluations (39 full evaluations) of CAM were found covering a range of therapies applied to a variety of conditions. The reporting quality of the full evaluations was poor for certain items, but was comparable to the quality found by systematic reviews of economic evaluations in conventional medicine. Regarding study quality, 14 (36%) studies were found to meet all four criteria. These exemplary studies indicate CAM therapies that may be considered cost-effective compared to usual care for various conditions: acupuncture for migraine, manual therapy for neck pain, spa therapy for Parkinson's, self-administered stress management for cancer patients undergoing chemotherapy, pre- and post-operative oral nutritional supplementation for lower gastrointestinal tract surgery, biofeedback for patients with "functional" disorders (eg, irritable bowel syndrome), and guided imagery, relaxation therapy, and potassium-rich diet for cardiac patients. Whereas the number and quality of economic evaluations of CAM have increased in recent years and more CAM therapies have been shown to be of good value, the majority of CAM therapies still remain to be evaluated.
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The Health Technology Assessment report on effectiveness, cost-effectiveness and appropriateness of homeopathy was compiled on behalf of the Swiss Federal Office for Public Health (BAG) within the framework of the 'Program of Evaluation of Complementary Medicine (PEK)'. Databases accessible by Internet were systematically searched, complemented by manual search and contacts with experts, and evaluated according to internal and external validity criteria. Many high-quality investigations of pre-clinical basic research proved homeopathic high-potencies inducing regulative and specific changes in cells or living organisms. 20 of 22 systematic reviews detected at least a trend in favor of homeopathy. In our estimation 5 studies yielded results indicating clear evidence for homeopathic therapy. The evaluation of 29 studies in the domain 'Upper Respiratory Tract Infections/Allergic Reactions' showed a positive overall result in favor of homeopathy. 6 out of 7 controlled studies were at least equivalent to conventional medical interventions. 8 out of 16 placebo-controlled studies were significant in favor of homeopathy. Swiss regulations grant a high degree of safety due to product and training requirements for homeopathic physicians. Applied properly, classical homeopathy has few side-effects and the use of high-potencies is free of toxic effects. A general health-economic statement about homeopathy cannot be made from the available data. Taking internal and external validity criteria into account, effectiveness of homeopathy can be supported by clinical evidence and professional and adequate application be regarded as safe. Reliable statements of cost-effectiveness are not available at the moment. External and model validity will have to be taken more strongly into consideration in future studies.
Article
The assertion that ‘local’ theories of homeopathy are traditional appears to be contradicted by Hahnemann's description of the action of homeopathic medicines as ‘spirit-like’. Entanglement theory prohibits the use of entangled states to convey information. Experimental proof of entanglement can only come indirectly. The implications for clinical research include that positive results will probably be found only in large series and that studies should avoid imposing a causal framework.
Article
Background Health economists have largely ignored complementary and alternative medicine (CAM) as an area of research, although both clinical experiences and several empirical studies suggest cost-effectiveness of CAM. Objective To explore the cost-effectiveness of CAM compared with conventional medicine. Methods A dataset from a Dutch health insurer was used containing quarterly information on healthcare costs (care by general practitioner (GP), hospital care, pharmaceutica care, and paramedic care), dates of birth and death, gender and 6-digit postcode of all approximately 150,000 insurees, for the years 2006–2009. Data from 1913 conventional GPs were compared with data from 79 GPs with additional CAM training in acupuncture (25), homeopathy (28), and anthroposophic medicine (26). Results Patients whose GP has additional CAM training have 0–30% lower healthcare costs and mortality rates, depending on age groups and type of CAM. The lower costs result from fewer hospital stays and fewer prescription drugs. Discussion Since the differences are obtained while controlling for confounders including neighborhood specific fixed effects at a highly detailed level, the lower costs and longer lives are unlikely to be related to differences in socioeconomic status. Possible explanations include selection (e.g. people with a low taste for medical interventions might be more likely to choose CAM) and better practices (e.g. less overtreatment, more focus on preventive and curative health promotion) by GPs with knowledge of complementary medicine. More controlled studies (replication studies, research based on more comprehensive data, cost-effectiveness studies on CAM for specific diagnostic categories) are indicated.
Article
Dentists who accept social security patients in Germany today are bound by a large number of rules and regulations which impose severe limits on their free choice of treatment, cost-effectiveness being a prime consideration. The treatment of acute conditions predominates in a modern compulsory insurance practice. The author analysed his own case records and the statistics provided by the KZV (association of dental practitioners for patients with compulsory insurance) for the period from 1983 to 1990 to establish the effect of introducing consistent use of homœopathic treatment from the end of 1984 on the frequency with which certain standard treatments were required. The results were compared with the average figures of other dentists and a computation made of potential economic advantages at a national level.
Article
In the course of developing a standardised, non-disease-specific instrument for describing and valuing health states (based on the items in Table 1), the EuroQol Group (whose members are listed In the Appendix) conducted postal surveys in England, The Netherlands and Sweden which indicate a striking similarity in the relative valuations attached to 14 different health states (see Table 3). The data were collected using a visual analogue scale similar to a thermometer (see Table 2). The EuroQol Instrument Is Intended to complement other quality-of-life measures and to facilitate the collection of a common data set for reference purposes. Others interested in participating in the extension of this work are invited to contact the EuroQol Group.
Article
Homeopathy is based on the idea of 'let like be cured by like'. It was founded by Samuel Hahnemann in the late 18th century, although similar concepts existed earlier. Homeopathy became popular in the 19th century in part because of its success in epidemics but declined during most of the 20th century. Its popularity increased in the late 20th and early 21st centuries in many parts of the world. Homeopathy is controversial because of its use of highly dilute medicines. There is a significant body of clinical research including randomised clinical trials and meta-analyses of such trials which suggest that homeopathy has actions which are not placebo effects. Cohort, observational and economic studies have yielded favourable results. There are several schools of homeopathy. Systems which use homeopathic medicines based on symbolism and metaphor are not homeopathy. Despite the long history of scientific controversy, homeopathy has proved resilient and is now geographically widespread. There is a significant body of scientific evidence with positive results. Homeopathy is an anomaly around which deserves further investigation.
Article
To test the feasibility of a pragmatic trial design with economic evaluation and nested qualitative study, comparing usual care (UC) with UC plus individualised homeopathy, in children requiring secondary care for asthma. This included recruitment and retention, acceptability of outcome measures patients' and health professionals' views and experiences and a power calculation for a definitive trial. In a pragmatic parallel group randomised controlled trial (RCT) design, children on step 2 or above of the British Thoracic Society Asthma Guidelines (BTG) were randomly allocated to UC or UC plus a five visit package of homeopathic care (HC). Outcome measures included the Juniper Asthma Control Questionnaire, Quality of Life Questionnaire and a resource use questionnaire. Qualitative interviews were used to gain families' and health professionals' views and experiences. 226 children were identified from hospital clinics and related patient databases. 67 showed an interest in participating, 39 children were randomised, 18 to HC and 21 to UC. Evidence in favour of adjunctive homeopathic treatment was lacking. Economic evaluation suggests that the cost of additional consultations was not offset by the reduced cost of homeopathic remedies and the lower use of primary care by children in the homeopathic group. Qualitative data gave insights into the differing perspectives of families and health care professionals within the research process. A future study using this design is not feasible, further investigation of a potential role for homeopathy in asthma management might be better conducted in primary care with children with less severe asthma.
Article
The application of conjoint analysis (including discrete-choice experiments and other multiattribute stated-preference methods) in health has increased rapidly over the past decade. A wider acceptance of these methods is limited by an absence of consensus-based methodological standards. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Research Practices for Conjoint Analysis Task Force was established to identify good research practices for conjoint-analysis applications in health. The task force met regularly to identify the important steps in a conjoint analysis, to discuss good research practices for conjoint analysis, and to develop and refine the key criteria for identifying good research practices. ISPOR members contributed to this process through an extensive consultation process. A final consensus meeting was held to revise the article using these comments, and those of a number of international reviewers. Task force findings are presented as a 10-item checklist covering: 1) research question; 2) attributes and levels; 3) construction of tasks; 4) experimental design; 5) preference elicitation; 6) instrument design; 7) data-collection plan; 8) statistical analyses; 9) results and conclusions; and 10) study presentation. A primary question relating to each of the 10 items is posed, and three sub-questions examine finer issues within items. Although the checklist should not be interpreted as endorsing any specific methodological approach to conjoint analysis, it can facilitate future training activities and discussions of good research practices for the application of conjoint-analysis methods in health care studies.
Article
One of five children visiting a homoeopathic physician is suffering from atopic eczema. To examine the effectiveness, safety and costs of homoeopathic versus conventional treatment in usual care. In a prospective multicentre comparative observational non-randomised study, 135 children (homoeopathy n = 48 vs. conventional n = 87) with mild to moderate atopic eczema were included. The primary outcome was the SCORAD (Scoring Atopic Dermatitis) at 6 months. Further outcomes at 6 and 12 months also included quality of life of parents and children, use of conventional medicine, treatment safety and disease-related costs. The adjusted SCORAD showed no significant differences between the groups at both 6 months (homoeopathy 22.49 + or - 3.02 [mean + or - SE] vs. conventional 18.20 + or - 2.31, p = 0.290) and 12 months (17.41 + or - 3.01 vs. 17.29 + or - 2.31, p = 0.974). Adjusted costs were higher in the homoeopathic than in the conventional group: for the first 6 months EUR 935.02 vs. EUR 514.44, p = 0.026, and for 12 months EUR 1,524.23 vs. EUR 721.21, p = 0.001. Quality of life was not significantly different between both groups. Conclusion: Taking patient preferences into account, homoeopathic treatment was not superior to conventional treatment for children with mild to moderate atopic eczema.
Article
The feasibility and outcomes of homeopathic therapy in a group of type-2 diabetes mellitus patients with diabetic neuropathy were studied in a prospective observational study. Patients were followed from baseline (T0) for 6 months (T1) and for 12 months (T2), treatment was adjusted as necessary. Primary outcome was diabetic neuropathy symptom (DNS) score, secondary outcomes were clinical evolution and short-form-36 (SF-36)-evaluated quality of life (QOL). Homeopathy was used in 45 patients, 32 of whom completed the observation study, and in parallel the conventional therapy outcomes were observed in 32 patients, 29 of whom completed the study. DNS improved in both groups during the observation period, but the change with respect to baseline was statistically significant only in Homeopathic group at T1 (P=0.016). Over the course of the observation there was a substantial stability of the electroneurophysiological values, blood pressure and body weight in both groups, a slight decrease of fasting blood glucose and glycated haemoglobin in Homeopathic group. QOL scores showed an improvement in Homeopathic group only. The cost of conventional drugs decreased in Homeopathic group from 114 euro/month to 94 euro/month at T1. Complementary homeopathic therapy of diabetic neuropathy was feasible and promising effects in symptom scores and cost savings were observed.
Article
Background & Objective In France, non-homeopathic general practitioners (GPs) often use antibacterials to treat children with recurrent acute viral rhinopharyngitis; whereas homeopathic GPs tend to use homeopathic medicines. We compared the effectiveness, the quality of life of the parents, and the direct and indirect costs associated with treatment from homeopathic and non-homeopathic GPs. Method We assessed the direct (consultations, medicines, further tests) and indirect (time off work) costs of the two types of treatment to society, the patient, and social security. We also assessed the effectiveness of the treatment received and the quality of life of the parents. Results Of the 499 children included, 231 were treated by 62 non-homeopathic GPs and 268 by 73 homeopathic GPs. The effectiveness (assessed as complications/patient, total number of adverse events, and quality of life) [mean overall Parents of children with Ear, Nose, and Throat infections Quality of Life questionnaire© scale score] was better in the homeopathic GP group than in the non-homeopathic GP group. No significant difference was found between the two groups for the total costs to social security (€98.55 for homeopathic GPs vs €96.17 for non-homeopathic GPs). Homeopathic GPs initiated preventive treatment in 82.2% of their patients and used antibacterials in 20.9% of their patients, while non-homeopathic GPs initiated preventive treatment in 43.3% of patients and prescribed antibacterials for 89.6% of patients. Conclusion This study produced new findings that indicate that, in France, acute rhinopharyngitis is handled differently by homeopathic GPs and non-homeopathic GPs: homeopathic GPs prescribe fewer antibacterials than non-homeopathic GPs for the treatment of recurrent acute rhinopharyngitis in children aged between 18 months and 4 years. Moreover, homeopathic treatment gave better results in terms of pragmatic medical effectiveness (fewer episodes and fewer complications) and the parents’ quality of life, with similar total medical costs to social security. However, this study is potentially biased by the lack of homogeneity of the two patient-samples in terms of the ‘passive smoking’, ‘patient age’, ‘childcare’, and ‘type of occupation’ criteria because our study protocol did not provide for prior matching of the two patient-samples with respect to these criteria. The observations found in this study need to be confirmed by randomized clinical trials.
Article
This article presents the results of a study to derive a preference-based single index from the SF-36. The study was an attempt to reconcile a profile health status measure, the SF-36, with the "quality adjusted life years" approach. The study undertook a parsimonious restructuring of the SF-36 using explicit criteria to form the SF-6D health state classification. A sample of multidimensional health states defined by this classification were valued by a convenience sample of health professionals, managers, and patients, who responded to a set of visual analogue scale ratings and standard gamble questions, with highly complete and consistent answers. Statistical models were estimated to predict single index scores for all 9000 health states defined by the new classification. The resultant algorithms can be applied to existing SF-36 data sets and used in the assessment of the cost-effectiveness of health technologies. This preliminary work forms the basis of a larger study currently being undertaken in the UK.
Article
The EuroQol Group first met in 1987 to test the feasibility of jointly developing a standardised non-disease-specific instrument for describing and valuing health-related quality of life. From the outset the Group has been multi-country, multi-centre, and multi-disciplinary. The EuroQol instrument is intended to complement other forms of quality of life measures, and it has been purposefully developed to generate a cardinal index of health, thus giving it considerable potential for use in economic evaluation. Considerable effort has been invested by the Group in the development and valuation aspects of health status measurement. Earlier work was reported upon in 1990; this paper is a second 'corporate' effort detailing subsequent developments. The concepts underlying the EuroQol framework are explored with particular reference to the generic nature of the instrument. The valuation task is reviewed and some evidence on the methodological requirements for measurement is presented. A number of special issues of considerable interest and concern to the Group are discussed: the modelling of data, the duration of health states and the problems surrounding the state 'dead'. An outline of some of the applications of the EuroQol instrument is presented and a brief commentary on the Group's ongoing programme of work concludes the paper.
Article
To ascertain the ability of a patient-generated outcome measure, the 'Measure Yourself Medical Outcome Profile' (MYMOP), to reflect the outcomes of consultations which patients consider are most important, as derived from qualitative interviews. A qualitative study using a constant comparative method to analyse semistructured interviews which were then compared with the results of MYMOP questionnaires. A variable-orientated analysis was used to develop themes and a case-orientated analysis was used to develop narrative summaries called vignettes from the interviews. The MYMOP questionnaire was completed by the interviewees (n = 20), a minimum to twice and a maximum of nine times over a four-month period. The scores were displayed on individual MYMOP charts. For each individual, the outcome as measured by MYMOP was compared with the outcome data from the qualitative interviews. The interviewees were attending a variety of complementary practitioners in primary care. The treatment effects which people described were encompassed by five themes: reduction in symptoms; reduction in disability; reduction in, or avoidance of, medication; gaining control and improving coping skills; and securing support and hope through the patient-practitioner relationship. The vignettes demonstrated how individuals identified and valued these various effects and weighed them up in evaluating the overall benefit of the treatment. Their MYMOP charts were able to measure some effects better than others. The treatment effects, as quantified using MYMOP, accorded with those described by most patients at interview, but some important limitations were identified with MYMOP, particularly an underplaying of the importance of medication avoidance or medication reduction in this patient group. This dimension is lacking in most outcome questionnaires and has been included in a new version of MYMOP. This study also showed that qualitative interview data can help in evaluating the ability of outcome questionnaires to measure the treatment effects that particular patient groups consider most important.
Article
Cardiovascular disease is the commonest cause of death and hospitalization in patients 65 years of age or older. The main offenders among the cardiovascular disorders in this age are CHD and hypertension. Many non-pharmacologic and pharmacologic measures in the middle-aged persons have confirmed for many years the effectiveness of primary and secondary prevention. Multiple intervention trials in the recent years have also demonstrated the effectiveness of these measures in patients 65 years of age and older. A summary of the main primary and secondary non-pharmacologic and pharmacologic measures that have been proven to be effective and useful in elderly patients has been presented with particular attention to hypertension and CHD. It also has been demonstrated that elderly patients have the capacity to follow the instructions of their physicians and that, as younger patients, they respond to these measures.
Article
The conventional antibiotic treatment of acute otitis media (AOM) faces a number of problems, including antibiotic resistance. Homeopathy has been shown to be capable of treating AOM successfully. As AOM has a high rate of spontaneous resolution, a trial to prove any treatment-effect has to demonstrate very fast resolution of symptoms. The purpose of this study was to find out how many children with AOM are relieved of pain within 12 h after the beginning of homeopathic treatment, making additional measures unnecessary. Two hundred and thirty children with AOM received a first individualized homeopathic medicine in the paediatric office. If pain-reduction was not sufficient after 6 h, a second (different) homeopathic medicine was given. After a further 6 h, children who had not reached pain control were started on antibiotics. Pain control was achieved in 39% of the patients after 6 h, another 33% after 12 h. This resolution rate is 2.4 times faster than in placebo controls. There were no complications observed in the study group, and compared to conventional treatment the approach was 14% cheaper.
Article
Homeopathy remains one of the most controversial subjects in therapeutics. This article is an attempt to clarify its effectiveness based on recent systematic reviews. Electronic databases were searched for systematic reviews/meta-analysis on the subject. Seventeen articles fulfilled the inclusion/exclusion criteria. Six of them related to re-analyses of one landmark meta-analysis. Collectively they implied that the overall positive result of this meta-analysis is not supported by a critical analysis of the data. Eleven independent systematic reviews were located. Collectively they failed to provide strong evidence in favour of homeopathy. In particular, there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo. It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.
Article
To examine the views of complementary and alternative medicine (CAM) groups on the need to demonstrate the effectiveness, safety and cost-effectiveness of their therapies and practices. Qualitative interviews were conducted with 22 representatives of three CAM groups (chiropractic, homeopathy and Reiki). Qualitative content analysis was used to identify similarities and differences among and across groups. Ontario, Canada. There were striking differences in the views of the three sets of respondents. The chiropractors agreed that it was essential for their group to provide scientific evidence that their interventions work, are safe and cost-effective. The leaders of the homeopathic group were divided on these points and the Reiki respondents showed virtually no interest in undertaking such research. CAM groups that are more formally organized are most likely to recognize the importance of scientific research on their practices and therapies.
Article
For people with dyspepsia who are receiving orthodox general practice care, what is the effect on outcome and on NHS costs of adding treatment by a choice of acupuncture or homeopathy? This paper describes and reflects upon a pilot study with user involvement. A randomised pilot study. Patients chose between acupuncture and homeopathy and were then randomised to this preference or to the control group of normal GP care. Sixty people with dyspepsia (>/=2 weeks) presenting in one UK general practice were recruited in consultations and by letter to those on repeat prescriptions. There were few exclusion criteria. The homeopath and the acupuncturist treated the patient individually according to their normal practice for up to 6 months. After the trial there was a focus group for participants. SF-36 health survey, Measure Yourself Medical Outcome Profile (MYMOP), and General Well-being Index (GWBI). Counts of prescriptions, consultations and referrals from practice computer records. No trend or significant difference between the groups for clinical outcome or NHS costs. Major costs for the 6 months, mean (S.D.) cost per patient, were general practitioner consultations pound 8 (18), prescriptions pound 64 (73), acupuncture pound 175 (52), homeopathy pound 105 (33). Participants gave insights and suggestions which will inform the full trial design. Reflection on the pilot study data and experience by participants, treating practitioners and researchers led to modifications in the design and a sample size calculation. How to demonstrate individual responses to treatment remains a problem.
Article
This study aimed to evaluate the effect of a GP-led practice-based homeopathy service on symptoms, activity, wellbeing, general practice consultation rate and the use of conventional medications. Data were collected for 97 consecutive patients referred to a homeopathy service between 1 July 2002 and 23 January 2003. Self-rated symptom severity, activity limitation and wellbeing were scored on a seven-point scale at initial homeopathic consultation and via postal questionnaire at a mean follow-up time of 134 days. Primary symptoms improved by a mean of 2.49 points (95% confidence interval (CI) 2.08-2.90; P < 0.0001); secondary symptoms by 2.49 points (95% CI 2.00-2.98; P < 0.0001); ability to undertake activity by 2.43 points (95% CI 1.95-2.91; P < 0.0001) and wellbeing by 1.41 points (95% CI 1.02-1.80; P < 0.0001). Following use of the homeopathy service the mean 6-month general practice consultation rate decreased by 1.18 consultations per patient (95% CI 0.40-1.99; P = 0.004). Fifty-seven per cent of patients reduced or stopped taking their conventional medication, saving 2,807.30 Pounds per year. The main limitation of this study is the absence of a control group. The findings warrant further research including controlled studies and economic analysis.
Article
The authors' experience of conducting clinical trials in homeopathy and analysing data from these has drawn attention to a fundamental problem with the interpretation of results from placebo controlled trials in homeopathy: It is not reasonable to assume that the specific effects of homeopathic medicine and the non-specific effects of consultations are independent of each other-specific effects of the medicine (as manifested by patients' reactions) may influence the nature of subsequent consultations and the non-specific effects of the consultation may enhance or diminish the effects of the medicine. For clinical trials of homeopathy to be accurate representations of practice, we need modified designs that take into account the complexity of the homeopathic intervention. Only with such trials will the results be generalisable to homeopathic practice in the real world. The authors propose that comparative trials are a meaningful way of evaluating the effectiveness of homeopathic treatment.
Article
Economic evaluation, linking the costs and consequences of an intervention to indicate the potential benefits of alternative interventions, is becoming established as one of the core tools for decision making in health care. As knowledge of the safety and effectiveness of complementary and alternative medicine (CAM) interventions increases, economic evaluation within CAM has a heightened significance. To explore whether the present framework for economic evaluation fits CAM and what modifications if any are needed for its application. Design: Systematic review. A comprehensive search of four databases was undertaken (NHS Economic Evaluation Database, AMED, MEDLINE, CINAHL). Studies were included if they took the form of a comparative analysis of costs and consequences of a CAM treatment and were written in English. Each study was reviewed using a set of methodological questions to judge their quality as economic evaluations. A total of 19 studies were identified, of which 9 were cost-effectiveness studies, 7 cost-consequence studies, 2 cost-minimization studies, and 1 cost-benefit analysis. Seventeen (17) of the studies involved CAM treatments being used alongside mainstream or conventional treatments. The majority of the treatments aimed to alleviate pain, including chronic pain, back pain, neck pain, and migraine. Only a small minority of studies addressed wider outcomes of particular relevance to CAM disciplines. Nine (9) adopted a service provider perspective only, 7 included wider sickness absence costs and 3 patient costs. Only 1 study included costs to relatives. The quality of the cost and benefit dimensions of the studies was mixed. A CAM sensitive approach to economic evaluation is required. This needs to include a focus on outcomes that explore the range of effects of CAM treatment, an exploration of the client's perspective and not just that of the service provider and study designs that facilitate the individualized practitioner approach so central to CAM treatment.
Article
A pharmacoeconomic study to compare, in terms of: medical effectiveness, quality of life and costs two treatment strategies ('homeopathic strategy' vs 'antibiotic strategy') used in routine medical practice by allopathic and homeopathic GPs in the treatment of recurrent acute rhinopharyngitis in 18-month to 4-year-old children. Statistical analysis of data obtained from a population of 499 patients included in a previous 6-month prospective, pragmatic study. The patients were regrouped according to type of drug prescribed. Medical effectiveness was assessed in terms of (i) episodes of acute rhinopharyngitis, (ii) complications, (iii) adverse effects. Quality of life was assessed using the Par-Ent-Qol scale. Direct medical costs (medical consultations, drug prescriptions, prescriptions for further tests) and indirect medical costs (sick-leave) were evaluated from three viewpoints (society, patient, Social Security) using public prices and French Social Security tariffs. The 'homeopathic strategy' yielded significantly better results than the 'antibiotic strategy' in terms of medical effectiveness (number of episodes of rhinopharyngitis: 2.71 vs 3.97, P<0.001; number of complications: 1.25 vs 1.95, P<0.001), and quality of life (global score: 21.38 vs 30.43, P<0.001), with lower direct medical costs covered by Social Security (88 Euros vs 99 Euros, P<0.05) and significantly less sick-leave (9.5% of parents vs 31.6% of parents, P<0.001). Homeopathy may be a cost-effective alternative to antibiotics in the treatment of recurrent infantile rhinopharyngitis.
Article
Observational studies have recently contributed useful information to the debate about the utility of homeopathic treatment in everyday practice. To gather data about routine homeopathic general practice. Eighty general medical practices in Belgium where physicians were members of the Unio Homoeopathica Belgica. All patients and their physicians visiting the practices on a specified day completed a questionnaire. A total of 782 patients presented with diseases of all major organ systems which were of sufficient severity to interfere with daily living in 78% of cases. Compared to previous conventional treatment, patients reported that consultations were much longer but costed less. One or more conventional drug treatments were discontinued in over half (52%) of the patients: CNS (including psychotropic) drugs (21%), drugs for respiratory conditions (16%) and antibiotics (16%). Conventional drugs were prescribed to about a quarter of patients (27%), mostly antibiotics and cardiovascular medication. The antibiotics were almost exclusively (95%) used to treat respiratory infections. Prescription costs (including conventional medicines) were one-third of the general practice average. Patients' satisfaction with their homeopathic treatment was very high (95% fairly or very satisfied), and ratings of their previous treatment was much lower (20%). The great majority (89%) said that homeopathy had improved their physical condition; 8.5% said that it had made no difference, 2.4% said that homeopathy had worsened their condition. Physicians' ratings of improvement were similar. Previous conventional treatment had improved 13% of patients, made no difference to 32%, and had worsened the condition of over half (55%). A similar pattern was seen for psychological symptoms. Patients were very satisfied with their homeopathic treatment, both they and their physicians recorded significant improvement. Costs of homeopathic treatment were significantly lower than conventional treatment, and many previously prescribed drugs were discontinued.
Article
The assertion that 'local' theories of homeopathy are traditional appears to be contradicted by Hahnemann's description of the action of homeopathic medicines as 'spirit-like'. Entanglement theory prohibits the use of entangled states to convey information. Experimental proof of entanglement can only come indirectly. The implications for clinical research include that positive results will probably be found only in large series and that studies should avoid imposing a causal framework.
Article
Unlabelled: BACKGROUND AND PROBLEM: A main problem for the acceptance of many methods belonging to the broad spectrum of complementary and alternative medicine (CAM) is that there is no conceivable theoretical bridge between the mainstream biomedical model and CAM theories and practice. Although empirical evidence is one important side of the coin of credibility, theoretical feasibility is the other. History of science teaches that no amount of empirical evidence will convince sceptics and followers of more conventional paradigms as long as there is no good theoretical model to make empirical findings plausible. Methods and solution: I therefore propose to broaden the spectrum of theoretical concepts beyond the reigning local-causalist model toward a non-local model that encompasses effects as encountered in CAM. Such a model can be derived from a generalized and weaker version of quantum theory recently developed and published by my colleagues and I as weak quantum theory (WQT). This theoretical model predicts nonlocal correlations analogous to Einstein-Podolsky-Rosen (EPR)-like correlations in quantum mechanics proper. The discerning moment, though, is that these nonlocal correlations within WQT are not EPR correlations postulated to extend into the classical world, but a broader, generalized version of entanglement not dependent on the strict quantum nature of the system under question. WQT predicts entanglement between elements of a system if two variables or observables are complementary: one describing a global and one the local aspects of the system. Entanglement then ensues between those local elements of a system that are complementary to the global description or observable of that system. Discussion and conclusions: This paper explores this rather abstract and general notion and expands it into more concrete examples. It is at the moment a purely explanatory structure, which, however, lends itself to exact empirical testing due to rather precise predictions, which will be developed. Because this structure of generalized entanglement is ubiquitous and also operative in conventional medicine, and because it is derived from one of the strongest theories that science has developed so far, it would constitute a theoretical bridge between the different medical and scientific traditions.
Article
To evaluate the effectiveness of homoeopathy versus conventional treatment in routine care. Comparative cohort study. Patients with selected chronic diagnoses were enrolled in medical practice. Conventional treatment or homeopathy. Severity of symptoms assessed by patients and physicians (visual rating scale, 0-10) at baseline, 6 and 12 months and costs. The analyses of 493 patients (315 adults, 178 children) indicated greater improvement in patients' assessments after homoeopathic versus conventional treatment (adults: homeopathy from 5.7 to 3.2; conventional, 5.9-4.4; p=0.002; children from 5.1 to 2.6 and from 4.5 to 3.2). Physician assessments were also more favourable for children who had received homoeopathic treatment (4.6-2.0 and 3.9-2.7; p<0.001). Overall costs showed no significant differences between both treatment groups (adults, 2155 versus 2013, p=0.856; children, 1471 versus 786, p=0.137). Patients seeking homoeopathic treatment had a better outcome overall compared with patients on conventional treatment, whereas total costs in both groups were similar.
Article
This paper reports an audit of clinical outcome in 455 consecutive patients (1100 consultations) presenting for private homeopathic treatment of a chronic illness in which conventional treatment had either: failed, reached a plateau in effect, or was contra-indicated by side effects, age or condition of the patient. Three hundred and four patients (66.8%) derived benefit from homeopathic treatment. One hundred and forty-eight patients (32.5%) were able to stop or maintain a substantial reduction in their conventional drugs. The 10 most frequent clinical conditions treated were eczema, anxiety, depression, osteoarthritis, asthma, back pain, chronic cough, chronic fatigue, headaches and essential hypertension. These 195 patients constitute 43% of the total, 151 of them (77%) were improved. The success rate of treatment is similar between age ranges. There was a difference in outcome between the sexes in adults: 296 females treated, success rate 71.3%; 159 males treated, success rate 58.5%. Two patients (0.4%) had prolonged aggravation of their presenting complaints apparently attributable to homeopathic treatment.
Article
A retrospective audit was carried out on 58 patients with chronic health problems who were referred by 22 general practitioners (GPs) for acupuncture, aromatherapy, homeopathy, massage and osteopathy, or a combination. Costs of GP consultations, prescriptions, secondary care referrals, and diagnostic tests from records of 33 of these patients were compared pre (24 months), during (mean 4.3 months) and post (mean 5.7 months) complementary medicine (CM) treatment. Patient centred outcome data included the Measure Yourself Medical Outcome Profile (MYMOP) and content analysis of patient and practitioner comments. Costs of GP consultations/patient/month were significantly higher during (20.10 pounds, p<0.001) and post (17.53 pounds, p<0.01) CM treatment compared with pre-treatment costs (11.27 pounds). Total prescription costs were not significantly higher during and post-treatment than pre-treatment. Prescription costs for referred conditions were lower during (2.26 pounds) and higher post-treatment (3.75 pounds) compared with costs pre-treatment (3.24 pounds). Pre- and post-treatment MYMOP scores indicated significant improvements in health and well-being. Longer follow up, is required in order to demonstrate significant cost savings related to CM provision. Cost comparisons with conventional medicine should consider quantitative and qualitative data to capture the wider benefits experienced by patients.
Article
Complementary and alternative medicine (CAM) is growing in popularity among patients, for an increasing range of conditions. However, current provision of CAM in the National Health Service in the UK is limited, patchy and disparate, which results in considerable inequity and patient unease. This has led to an escalation in the debate about the role of CAM within the NHS. Lack of evidence about the cost effectiveness of CAM therapies compared with other forms of care is often cited as the main reason for the reluctance of funders to integrate CAM into mainstream service provision. Cost-effectiveness relies on evidence about costs and benefits. Cost data are relatively straightforward to collect but it has proved difficult to value the complete package of benefits offered by CAM, likely to be both process and outcome based, in a way that can be compared with alternatives. Stated preference discrete choice modelling (SPDCM), a method of healthcare evaluation growing in popularity, uses information about patient preferences to identify the important characteristics of an intervention or method of delivering care and how patients value these. SPDCM is a method that could be used to evaluate the 'added value' provided by CAM and thus supply evidence on cost-effectiveness that policy makers could use in configuring service provision.
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