Efficacy, effectiveness and efficiency of acupuncture in patients withosteoarthritis of the knee or the hip – the acupuncture randomized trial(ART) and the acupuncture routine care study (ARC)
1)Witt CM, 1)Brinkhaus B, Reinhold T, 1)Jena S, 2)Linde K,2)Melchart D, 1)Willich SN

1)Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin,

Germany

2)Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität

München, Munich, Germany

Objective: The aim of our studies was to evaluate: 1) the efficacy of acupuncture compared to minimal
acupuncture and compared to a waiting list control in patients with osteoarthritis of the knee and 2)
the effectiveness and cost-effectiveness of acupuncture (in addition to routine medical care) in patientswith osteoarthritis of the hip or knee.
Methods: 1) In the Acupuncture Randomised Trial (ART) patients with pain due to osteoarthritis of theknee were randomised to treatment with semi-standardised acupuncture (AC), minimal acupuncture(MA, superficial needling at non acupuncture points) or to waiting list control (WL). AC and MA
consisted each of 12 sessions per patient over 2 months. The primary outcome parameter in theosteoarthritis trial was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC)
Index after 2 months.
2) In the Acupuncture in Routine Care Study (ARC) patients with chronic arthritis of the hip and theknee were randomly allocated to: receive up to 15 acupuncture sessions over three months (ACU), or toa control group (CON) receiving no acupuncture. Study participants were allowed to receive additional
usual medical care covered by social health insurance funds. Primary outcome parameter was theWOMAC Index after 3 months. Data for direct costs and sick leave were provided by the social healthinsurance funds. The cost-effectiveness-analysis was performed from an overall cost perspective.
Incremental cost-effectiveness-ratios (ICER) were calculated using quality adjusted life years (QALYs)
after 3 months.
Results: 1) In ART, 294 patients (66% female, 64±7 years (mean±sd)) were enrolled. The meanbaseline-adjusted WOMAC Index at 2 months was 26.9±1.4 (mean±SE) in the AC, 35.8±1.9 in MA
group and 49.6±2.0 in the WL group. The difference for the AC vs. MA group was -8.8 (95% CI -13.5 to-4.2, p<0.001) and for the AC vs. WL group was -22.7 (27.5. to -17.9, p<0.001). 2) In ARC, 632 patientswere included (61% female, mean age 61.8±10.8 years (mean±sd)). At three months, the WOMAC
index improved by 17.6±1.0 (mean±SE) to 30.5±1.0 in the ACU group and by 0.9±1.0 to 47.3±1.0 in
the CON group, difference 16.7±1.4, p<0.001. Additional acupuncture treatment was associated withhigher overall costs during 3 months compared to routine care alone (€ 1,218 vs. € 706 p<0.001). There
were more QALYs gained in the ACU compared to the CON (ACU-CON: 0.02±0.01). The incremental
cost effectiveness ratio was € 17,845 per QALY gained.
Conclusion: Acupuncture treatment was superior to minimal acupuncture and to waiting list control inpatients with osteoarthritis of the knee. In addition routine medical care plus acupuncture was more
effective than routine care alone but resulted in additional costs. However, according to international
health economics benchmarks it can be regarded as cost-effective.