Abstract
OBJECTIVE: To assess the lifetime cost-effectiveness of acupuncture in the prevention of episodic migraine from both a Canadian public health care payer and societal perspective. BACKGROUND: Acupuncture has been used for pain relief for thousands of years in China and could be an alternative to drugs in managing pain. Nevertheless, there is limited evidence to determine if acupuncture is cost-effective in migraine prevention in the Canadian setting. METHODS: A cost-utility analysis with a decision-analytic Markov model was constructed to compare acupuncture with drug prophylaxis and no active treatment among adult patients with episodic migraine over their lifetime. The efficacy inputs (migraine days) were based on a Cochrane systematic literature review. Quality-adjusted life years (QALYs) were the modeled health outcome. Direct and indirect medical costs were derived from a Canadian burden of illness study on patients with migraine. All costs were inflated and reported as the present value of lifetime costs in 2021 Canadian dollars (CAD), discounting at 1.5%. RESULTS: From a health system perspective, acupuncture was cost-effective when compared with no active treatment (CAD 35,060/QALY) and drug prophylaxis (CAD 47,128/QALY) at a willingness-to-pay threshold of CAD 50,000/QALY gained. Acupuncture was dominant compared with no active treatment and drug prophylaxis from a societal perspective. Cost savings were driven by reduced productivity loss from fewer migraine days with acupuncture treatment. CONCLUSION: Acupuncture could be a cost-effective option for patients with episodic migraine. Future studies are encouraged to inform decisions regarding the use of acupuncture in the management of episodic migraine.