Are Your Complementary and Integrative Healthcare Choices Cost-Effective?
Cost effectiveness is a big question for major stakeholders in healthcare. Employers, insurers, and government agencies like Medicare can decide not to cover effective complementary, alternative, or integrative approaches if they are worried about cost. Evidence of effectiveness alone often fails to make the grade.
But what about you, the consumer, healthcare’s most significant stakeholder: Is cost-effectiveness—that is, the relative cost to “usual care”—a big issue in your purchasing decisions?
This question has rarely been pursued by researchers. When consumers are asked if they believe that their use of complementary and alternative medicine diminishes use of pharmaceuticals, conventional visits, procedures, or surgeries, 50 to 65 percent say yes. The highest percentages in these surveys are among those who have visited practitioners, rather than those who merely practice CAM self-care. (You can see a table with some of these outcomes in a column I wrote in Medical Economics some years ago by placing “Is Alternative Medicine More Cost Effective?” in quotes in your search engine.)
In addition, consumer surveys suggest that hard economic times influence people to use more dietary supplements and natural remedies. I know personally that a change in my family insurance is changing our purchasing. We recently moved from a blue chip, low-deductible plan through my spouse’s former university position to a high-deductible, catastrophic plan now that we are each self-employed. We have increased our focus on smart use of natural health and integrative products and services.
Unfortunately for all stakeholders, the research community doesn’t seem to think cost-effectiveness is worth much exploration—even if Congress directly charges them to do so.
Here is the case in point: An agency of the US government, the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health, was charged with helping us understand the cost and effectiveness outcomes at its founding in 1998. US senators Tom Harkin (D-IA), Barbara Mikulski (D-MD), Orrin Hatch (R-UT) and others told NCCAM to keep real-world questions the top priority. The mandate says to focus on “outcomes research” and, more specifically, a field called “health services research,” which includes costs. Congress was explicit: they wanted information to help us understand the integration of these modalities, systems, and disciplines “into healthcare delivery systems in the United States.”
What happened? An internal NCCAM review from 2002 to 2006 showed less than one percent of all NCCAM funds focused on outcomes of any kind. And only a quarter of this minute investment examined costs. The agency simply turned its back on Congress and continued its preferred priorities: examinations of mechanism and basic research.
The loss to all decision-makers—you and those whose choices alter what may be covered in your benefit plans—from this abdication of responsibility was made clear in a scientific report recently published in British Medical Journal Open. A team of researchers led by economist, clinician, and NCCAM-funded researcher Patricia Herman, MS, ND, PhD, and Harvard’s David Eisenberg, MD, examined the world’s literature. They sought all studies on cost-effectiveness in complementary and integrative medicine from 2001 to 2010. The review was called “Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations.” Guess how many high-quality studies they found?
Twenty-eight. That’s less than two-and-a-half studies per year, globally. The number is almost unbelievably low, given the rise in consumer interest and use.
The good news for CAM users is that this survey should muzzle CAM naysayers who disbelieve in any potential cost contributions from these fields. In an interview, Herman put it this way: “I’m tired of this talk that there is no evidence for cost-effectiveness of complementary and integrative medicine. There is evidence. We need to move onto phase two and look at how transferable these findings are. We can take this evidence and run.”
So how do we get Herman’s “phase two” moving? Heavy lifting, that’s how.
Given the research community’s resistance, a little popular prodding is in order. Write to your members of Congress and to Senator Harkin. Tell them you want NCCAM to do what they, Congress, asked. Tell them you are tired of NCCAM’s noncompliance. Let them know that in our nation’s horrible healthcare cost crisis we need to explore the potential contributions of these approaches, providers, and disciplines. Tell them you think we might learn about deeper health reform if we examine the effectiveness and cost outcomes of the health-focused, whole-person approaches of acupuncturists, naturopathic doctors, chiropractors, massage therapists, yoga teachers, holistic nurses, and integrative medical doctors.
Clearly we should be leaving no stone unturned in shifting our nation’s unsustainable healthcare economics. Given the consumer use of complementary, alternative, and integrative approaches and providers, more cost-effectiveness studies are warranted. They would help the home economics of many families.
John Weeks is the editor of “The Integrator Blog News and Reports” (theintegratorblog.com), a leadership-oriented news, networking, and organizing journal for the integrative-medicine community, and a columnist for Integrative Medicine: A Clinician’s Journal.