Cost-Effectiveness of Pharmacopuncture Versus Conventional Acupuncture for Insomnia: An RCT-Based Economic Evaluation with a Markov Model.

Researchers in South Korea studied whether pharmacopuncture—a treatment combining traditional acupuncture with herbal medicine injections at acupoint sites—is cost-effective for treating insomnia compared to regular acupuncture and electroacupuncture. The study followed 100 participants with moderate-to-severe insomnia over six months, tracking both their sleep improvements and healthcare costs. The researchers used the Insomnia Severity Index to measure symptom severity and calculated quality-adjusted life years (QALYs) to assess overall health benefits.

The findings showed that pharmacopuncture helped more patients achieve remission (an insomnia score below 8, indicating minimal symptoms) but cost approximately $270 more per additional patient who achieved remission over eight weeks. Over six months, the cost was about $12,600 per QALY gained. While these numbers might sound high, health economists in Korea consider treatments cost-effective if they cost less than $21,740 per QALY, meaning pharmacopuncture falls well within acceptable limits.

For patients considering treatment options, this research suggests that pharmacopuncture offers good value despite higher upfront costs compared to conventional acupuncture. The combination approach may provide stronger therapeutic effects for persistent insomnia. However, pharmacopuncture is not currently covered by Korean National Health Insurance, so patients would need to pay out-of-pocket. The study's authors suggest this treatment could be considered for future insurance coverage based on these positive cost-effectiveness results. If you're interested in pharmacopuncture for insomnia, consult with a licensed acupuncturist trained in this specialized technique to determine if it's appropriate for your specific situation.

This pragmatic RCT-based economic evaluation (n=100) assessed pharmacopuncture versus conventional acupuncture modalities for moderate-to-severe insomnia using dual Markov models with 8-week and 24-week time horizons. Transition probabilities were based on Insomnia Severity Index (ISI) scores stratified into four severity levels. Primary outcomes included remission rates (ISI <8) and QALYs from a healthcare system perspective. Pharmacopuncture demonstrated an incremental cost-effectiveness ratio (ICER) of KRW 368,000 (USD 270) per additional remission over 8 weeks and KRW 16,940,000 (USD 12,600) per QALY over 24 weeks. At South Korea's willingness-to-pay threshold of KRW 27,660,000 (USD 21,740) per QALY, pharmacopuncture proved cost-effective compared to standard acupuncture and electroacupuncture. Sensitivity analyses indicated cost-effectiveness was most sensitive to pharmacopuncture pricing variations. Clinical implications support pharmacopuncture as an economically viable treatment option for insomnia management, potentially warranting consideration for national health insurance coverage expansion in jurisdictions where it remains an out-of-pocket expense.