Complementary medicine – an efficient element for sustainable health budgets? Stefan N. Willich Institute for Social Medicine, Epidemiology and Health Economics Charité University Medical Center Berlin, Germany

Medicine from Descartes to Watson/Crick 19th Century21th Century Medicine within natural science Body/soul dualism Human as a machine Repair mechanisms Principle of causality „We live forward but we understand backward“ (William Jones)

Complementary Medicine (alternative, unconventional, holistic)  Various approaches in theory and medical practise  Encouragement of constitutional regulation  Anthropological image of man  Healing: -Somatic intervention -Salutogenesis -Development by illness Willich et al., Dtsch Ärzteblatt 2004;101:A

Visits to Practitioners of Alternative Therapies (USA ) Eisenberg DM et al., JAMA 1998;280: Visits to Practitioners of Alternative Therapies Visit to All Primary Care Physicians Visits to Practitioners of Alternative Therapies Visit to All Primary Care Physicians

Utilization and Cost of Complementary and Alternative Medicine in Germany  Utilization of alternative medicine70 %  Natural remedies in the last 3 months30-40 %  Physicians with education in CAM10 %  Natural remedies (44% prescribed)2 Bill. Euro  Visits at physicians2 Bill. Euro  Private treatment / over the counterca. 5 Bill. Euro RKI 2001; Allensbach/Stat. Bundesamt 2002

Frequency of Complementary Medicine Utilization (12 Months) Härtel/Volger, Forsch Komplementärmed Klass Naturheilkd 2004;11: Total (n=1100) Men (n=551) Women (n=549) Naturopathic treatment (%) Chirotherapy (%) Homeopathy (%) Acupuncture (%)9611 TCM (%)212 Ayurveda (%)10,41 Anthroposophic treatment (%)10,32

Use of Alternative Therapies (108 Oncology Patients) 23% of the patients planned to start an alternative therapy after completing their conventional treatment Van der Weg and Streuli 2003

Reasons for use of AT Van der Weg and Streuli 2003

Percentage of phytopharmaca Proportion of Alternative Medication Prescriptions IMS Health - Panel Percentage of homeopathica

Results Patients 65% women (age: 49  14 years) 35% men (age: 52  14 years) 10  3 Acupuncture treatments

Diagnoses

Osteoarthritis of the Knee (Gon-ART) Witt et al. Lancet 2005;366:

Headache Days (Migrane-ART) Linde et al. JAMA 2005;293:

Comparison of Costs (Over 3 Months) Costs of Routine TreatmentCosts of Acupuncture Total cost per patient 0-3 months after begin of study Low back pain Headache Arthritis Neck pain All. Rhinitis/ Asthma Dysmenorrhea

International threshold values 30,000 GBP – 50,000 € Cost-Effectiveness-Analysis ICER, Euro per Qaly gained

Willich SN et al. submitted Cost-effectiveness Acceptability Curve and Sensitivity Analyses of Acupuncture in Osteoarthritis Pain

minor 8.5% no 91% major 0.8% (3 cases of pneumothorax) Adverse Events 261,897 completed treatments (with 10 sessions of acupuncture each)

Study Design Prospective, comparative, multicenter cohort study First treatment by doctor Age > 16 years Diagnosis of chronic illness: - Headache - Low back pain - Depression - Sleep disorders - Sinusitis HomeopathicConventional Medicine Patients Doctors Witt C et al., Complement Ther Med 2005;13:79-86

Patients‘ Rating of Complaints Overall Diagnoses (Adjusted) Diagnoses Headache Low back pain Depression Sleep disorders Chron. Sinusitis Witt C et al., Complement Ther Med 2005;13:79-86 Homeopathy o Conventional

Physicians’ Rating of Complaints Overall Diagnoses (Adjusted) Witt C et al., Complement Ther Med 2005;13:79-86 Diagnoses Headache Low back pain Depression Sleep disorders Chron. Sinusitis Homeopathy o Conventional

Total Costs* Overall Diagnoses * Inpatient, outpatient treatment (incl. homeopathy), drugs, aids to daily living, sick-pay, physical therapy Witt C et al., Complement Ther Med 2005;13:79-86 Adjusted analysis: Homöo/Schul p=ns Homöo: vor/nach p<0.001 Schul: vor/nach p<0.001 Homeopathy (n=66) Conventional (n=65) adjusted

Nefiodow LA 2000 Kondratieff-Cycles Basic Innovation Steam-engine Textile industry Steel Railway Electrical/ chemical engineering Automobile Petro- chemistry Information Technology Psycho- social Health Major Application ClothingTransportMass consumption Individual mobility Globalization Communic. Health Education 1. Kondratieff2. Kondratieff3. Kondratieff4. Kondratieff5. Kondratieff6. Kondratieff XX

Summary  Widespread utilisation of complementary therapies  Established study methodology applicable to complementary medicine  Acupuncture in routine care: clinical benefit and cost effective within common threshold  Homeopathic treatment tends to be superior to conventional medicine at same cost  Cooperation between complementary and conventional medicine urgently needed