Model-based economic evaluation of pharmacopuncture for chronic low back pain: a 3-year Markov analysis.

Researchers in Korea conducted an economic study to determine whether pharmacopuncture—a technique combining acupuncture with herbal medicine injections at specific points—offers good value for treating chronic low back pain compared to standard physiotherapy. Chronic low back pain is the leading cause of disability worldwide and drives significant healthcare costs, prompting interest in effective non-drug treatments.

The study used a Markov model, a mathematical tool that projects health outcomes over time, tracking patients through three pain levels (mild, moderate, severe) over three years. Clinical data came from a multicenter randomized controlled trial, and costs were calculated from both healthcare system and societal perspectives, including medical expenses, travel costs, and lost work productivity.

The findings were striking: pharmacopuncture was both less expensive and more effective than physiotherapy. From the healthcare perspective, pharmacopuncture cost $1,304 compared to $1,385 for physiotherapy while delivering better quality-of-life outcomes (2.30 versus 2.23 quality-adjusted life years). When including societal costs like productivity losses, the advantage became even more pronounced ($25,760 versus $31,962). The probability that pharmacopuncture represents good value was exceptionally high—over 97% from the healthcare perspective and 99% from the societal view.

For patients suffering from chronic low back pain, these results suggest pharmacopuncture may be a cost-effective alternative to conventional physiotherapy, potentially offering better pain relief and quality of life at lower overall cost. This aligns with World Health Organization priorities for integrating evidence-based traditional medicine into healthcare systems. If considering pharmacopuncture for chronic low back pain, seek treatment from a licensed acupuncturist with specialized training in injection techniques.

This Markov model-based economic evaluation compared pharmacopuncture (PPT) versus physiotherapy (PT) for chronic low back pain over three years using 3-month cycles across three health states (mild/moderate/severe pain). Clinical inputs derived from a multicenter pragmatic RCT with quality-adjusted life years calculated from EQ-5D-5L data. From the healthcare perspective, PPT dominated PT with lower costs ($1,304 vs. $1,385) and higher QALYs (2.30 vs. 2.23), yielding an ICER of -$1,145 per QALY. Societal perspective analysis strengthened dominance ($25,760 vs. $31,962). Probabilistic sensitivity analysis demonstrated 97.7% (healthcare) and 99.4% (societal) probability of cost-effectiveness at Korean willingness-to-pay thresholds. Results remained robust across deterministic sensitivity scenarios. This first model-based economic evaluation of pharmacopuncture for cLBP provides evidence supporting its potential as a high-value, non-pharmacological intervention, with implications for coverage decisions and sustainable pain management strategies.