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Zumi Mehta,Margaret English,Cecelia Trybus,Valerie Magda,Khalid Kamal 사단법인약침학회 2018 Journal of Acupuncture & Meridian Studies Vol.11 No.6
Toroski et al in their study, Comparison of the CostUtility Analysis of Electroacupuncture and Nonsteroidal Antiinflammatory Drugs in the Treatment of Chronic Low Back Pain, identifies a gap in the pharmacoeconomic literature regarding the treatment of chronic low back pain. There is evidence to demonstrate that traditional acupuncture is efficacious in the treatment of chronic low back pain; however, there are no studies comparing the effectiveness of electroacupuncture to other standards of care, such as nonsteroidal antiinflammatory drugs (NSAIDs). 1,2 Although this study aimed to answer a novel and relevant question, there are several limitations that prevent the study results from being generalizable and ultimately applicable to therapeutic decision-making. First, there is no description of the comparator. It is important to explain why NSAIDs were chosen as the comparator and what types and dosing schedules of NSAIDs were studied. Without this information, it is difficult to evaluate the true cost and effectiveness of NSAIDs. Second, the costs presented in the study are not transparent. It is challenging to analyze the specific costs, especially the direct nonmedical costs because they are not specified. Third, the study failed to present the results in the appropriate format; costeutility analyses require results in terms of qualityadjusted life years and incremental costeutility ratios. However, only utilities and average cost-effectiveness ratios were reported in the study. The average cost- effectiveness ratio is the ratio of the cost to benefit of an intervention without any comparisons to alternatives, and incremental costeutility ratio is always utilized when comparing different treatment options. Consequently, the results cannot be properly evaluated, and this study cannot be classified as a true costeutility analysis. Finally, because most pharmacoeconomic studies deal with assumptions and variable data, sensitivity analysis is a must in any pharmacoeconomic analyses. The study did not conduct any sensitivity analysis, thus not allowing for any uncertainty in the estimates of costs and consequences, which were already vague and difficult to decipher. Overall, this study aimed to answer a unique pharmacoeconomic question;however, its numerous limitations prevent its generalizability and overall usefulness in clinical decision-making for the treatment of chronic low back pain.
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