Research Project Grants

Dugald Seeley
Co-investigator:
Ed Mills, PJ Devereaux
CCNM Research Department
Project Title:
Assessing the Cost Effectiveness of Complementary and Alternative Medicine: A Systematic Review of the Literature
Abstract:
Background: The usage of complementary and alternative medicine (CAM) is growing rapidly and already comprises a huge portion of expenses spent on 'private' health care. In the United States, an estimated 20 billion is spent yearly on visits to CAM providers and an additional 3 billion is spent on commercial diet supplements and megavitamins alone. Despite the enormous expenditures on CAM, there is very little in the way of information and understanding as to the cost benefits (or not) achieved through this financial outlay. The impact of CAM on the use of conventional medicine needs analysis in order to assess the economic benefits derived from this "secondary" system of medicine.
                        Objectives: To gather and assess published and unpublished studies that assess the overall cost effectiveness of CAM in comparison to conventional medicine.
                        Methods: Using previously developed methods (Devereaux et al., 2004), we will include published and unpublished studies (observational and randomized) that directly compare payments for care at CAM clinics to expenses incurred at conventional medical clinics. As we require an estimate of variance for precision of the estimate of relative payments, we will exclude studies that do not provide this information.
                        We will search 12 electronic databases (EMBASE, MEDLINE, HealthStar, CINAHL, BioethicsLine, Wilson Business Abstracts, EconLit, Cochrane Library, Dissertation Abstracts Ondics, ABI/Inform, NTIS and SciSearch) (1966 - present); consult with experts; review our own files; review reference lists of related articles; use "related articles" function of PubMed; and use SciSearch for publications that meet our eligibility criteria. A medical librarian will assist with searchers. We will also contact insurance corporations to determine the
                        We will choose titles and abstracts independently, in duplicate. We will mask all data eligibility assessors to the results of articles by blacking them out. We will assess kappa scores on agreement of inclusion. We will abstract information on the following: sampling method, sources of data, case mix, type of clinic/intervention tested, dates of data collection, duration of patient follow-up, number of clinics assessed, patient source of payment (e.g., private insurance), and potential confounders. We will assess the methodological quality of studies using criteria related to adjustments.
                        If possible we will meta-analyze the studies using a random effects model, as this model gives greater weight to studies with smaller variance. A priori explanations of heterogeneity include the interventions, the setting (country), adult or children, source of payments, and methodological quality. We will test for heterogeneity using the z-test and the I2 test. We will conduct a visual inspection of funnel plots to assess evidence of publication bias.
                        Significance: There is very little in the way of understanding as to what impact CAM usage has on the use of conventional medicine and what potential cost savings are incurred by the public health care system as a result. This systematic review will provide a synthesis of information currently unavailable that is of direct relevance to the public, insurance corporations, the government and public policy makers.
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12 Feb 06