Summary: Preliminary results of a systematic review of approximately 6600 articles so far found 256 with CAM economic evaluations. Forty-eight were deemed “high quality,” with comparisons available. These yielded 9 therapies and 21 conditions where complementary and alternative medicine has generated evidence of not merely cost-effectiveness but of cost-savings. So reports the professional who is emerging as the leading North American voice on CAM costs, economist-practitioner-researcher Patricia Herman, ND, MS, PhD. Herman co-authored the paper on the economics of integrative medicine for the recent Institute of Medicine Summit on Integrative Medicine and the Health of the Public. She reported findings from her 80% complete systematic review of over 8,000 references at the August 2009 convention of the American Association of Naturopathic Physicians. Here are Herman’s top 9 therapies and 21 conditions.
The most critical piece of the puzzle needed for the uptake of more complementary and integrative practices into mainstream payment and delivery is quality evidence of cost-savings. Particularly in economic downturn, evidence of efficacy and even effectiveness are not enough.
So it was particularly intriguing to see a
presentation entitled “Systematic Review of Economic Evaluations: Can
CAM be Cost Saving?” at the August 19-22, 2009 convention of the American Association of Naturopathic Physicians (AANP).
The presentation was by a professional whose background is rare for a professional in any
healthcare field. The resume could be one-of-a-kind in integrative practice. Patricia Herman, ND, MS, PhD was a resource economist working for North American utilities on early green energy projects in her first profession before entering studies to become a licensed naturopathic physician. Herman subsequently completed two research fellowships on CAM economics funded by the NIH National Center for Complementary and Alternative Medicine.
Herman’s work has become increasingly visible, and respected, this year.
With Kenneth Pelletier, PhD, MD(hc), and others Herman co-authored the paper on the economics of integrative medicine for
the Institute of Medicine Summit. Attendees at the May 2009 North American Research Conference on
Complementary and Integrative Medicine heard her work called out and
honored from the podium of the final plenary session by economist and keynoter Dean Jamison, PhD. She offered economic insights as a participant on three panels and posters at the conference.
Characteristics of the search and review
Herman, who has previously reviewed evidence of CAM costs but not from this broad and inclusive a set of studies, independently took on this exhaustive review as part of a paper in preparation with Harvard Medical School’s David Eisenberg, MD. Her review included 34 search terms for CAM and 16 search terms for economics. She explored all available years in 6 databases. The searches yielded roughly 8000 references, which Herman is painstakingly examining. When completed the work will be be definitive for the field. Herman plans to continue updating it.
At the AANP, Herman reported completed analysis of 6600 of these articles, a work 82% complete. From these she found 256 CAM economic evaluations, 185 of which were published in the last 10 years. Herman caveated her presentation by underscoring that the findings remain preliminary in two ways. She has not only not completed the review, she hasn’t yet satisfied herself with enough of a detailed review of some studies.
with High Quality Evidence of Cost-Savings
| 9 Therapies
||Low back pain, oocyte removal, migraine
and symptoms after transurethral resection
|Back pain, neck pain, lumbar disc
herniation, ‘non-surgical’ M/S
(omega 3, arginine,
|Massage||Lymph node resection and adhesive
|Biofeedback||“Functional disorders,” e.g. irritable
bowel syndrome (IBS) and
temporomandibular disorders (TMD)
|Guided imagery and
|Cardiac surgery and post myocardial
|Self-hypnosis||Large core needle breast biopsy|
|Basic body awareness
|Moist burn ointment (^)||Partial-thickness burns <40% of
(^) Beta-sitosterol, berberine, other herbs
Herman reports that in the last decade there have been 48 “high quality” studies for which comparison is possible, that meet the criteria of being prospective, randomized and also show effectiveness of the CAM therapy. Of these, 21 (44%) showed cost-savings and another 20 showed the CAM intervention to be “cost-effective.” The table above shows the 9 CAM approaches which were found to be cost-saving based on these high-quality studies.
Herman concluded her slide presentation with a word to both payers and to researchers. To the former she says, bluntly: “It’s quite possible for CAM to reduce costs.” To researchers, Herman suggests a shift in practices: enter directly into testing effectiveness, and when you do, “try to also capture both cost of treatment and cost offsets.”
Comment: Responding to patient interest in “CAM” may be an insurer’s modus operandi in flush times when companies are feeling flush and may be competing for workers. In an economic down-turn, with cash tight, neither patient interest nor evidence of efficacy, and perhaps not even effectiveness, are likely to move the payer. Evidence of cost savings may be the only leverage for gaining inclusion.
Herman’s emerging work is a major contribution to the field. I look forward to the formal paper, and to the potential of having this regularly updated database available going forward. That way we can all be loaded for bear in forging the dialogue for inclusion.
for inclusion in a future Your Comments Forum.