The notion that the use homeopathy instead of real medicine might save money (heavily promoted by homeopaths and their followers, often to influence health politics) has always struck me as being utterly bizarre: without effectiveness, it is hard to imagine cost-effectiveness. Yet the Smallwood report (in)famously claimed that the NHS would save lots of money, if GPs were to use more homeopathy. At the time, I thought this was such a serious and dangerous error that I decided to do something about it. My objection to the flawed report might have prevented it being taken seriously by anyone with half a brain, but sadly it also cost me my job (the full story can be read here).
Later publications perpetuated the erroneous idea of homeopathy’s cost-effectiveness. For instance, an Italian analysis (published in the journal ‘Homeopathy’) concluded that homeopathic treatment for respiratory diseases (asthma, allergic complaints, Acute Recurrent Respiratory Infections) was associated with a significant reduction in the use and costs of conventional drugs. Costs for homeopathic therapy are significantly lower than those for conventional pharmacological therapy. Again, this paper was so badly flawed that, other than some homeopaths, nobody seemed to have taken the slightest notice of it.
Now a new article has been published on this very subject. The aim of this study was to compare the health care costs for patients using additional homeopathic treatment (homeopathy group) with the costs for those receiving usual care (control group).
Cost data provided by a large German statutory health insurance company were retrospectively analysed from the societal perspective (primary outcome) and from the statutory health insurance perspective. Patients in both groups were matched using a propensity score matching procedure based on socio-demographic variables as well as costs, number of hospital stays and sick leave days in the previous 12 months. Total cumulative costs over 18 months were compared between the groups with an analysis of covariance (adjusted for baseline costs) across diagnoses and for six specific diagnoses (depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache).
Data from 44,550 patients (67.3% females) were available for analysis. From the societal perspective, total costs after 18 months were higher in the homeopathy group (adj. mean: EUR 7,207.72 [95% CI 7,001.14-7,414.29]) than in the control group (EUR 5,857.56 [5,650.98-6,064.13]; p<0.0001) with the largest differences between groups for productivity loss (homeopathy EUR 3,698.00 [3,586.48-3,809.53] vs. control EUR 3,092.84 [2,981.31-3,204.37]) and outpatient care costs (homeopathy EUR 1,088.25 [1,073.90-1,102.59] vs. control EUR 867.87 [853.52-882.21]). Group differences decreased over time. For all diagnoses, costs were higher in the homeopathy group than in the control group, although this difference was not always statistically significant.
The authors of this paper (who have a long track record of being pro-homeopathy) concluded that, compared with usual care, additional homeopathic treatment was associated with significantly higher costs. These analyses did not confirm previously observed cost savings resulting from the use of homeopathy in the health care system.
The next time someone does a (no doubt costly) cost-effectiveness analysis of an ineffective treatment, it would be good (and cost-effective) to remember: WITHOUT EFFECTIVENESS, THERE CAN BE NO COST-EFFECTIVENESS.
“So what? We all know that homeopathy is nonsense,” I hear some people argue, “at the same time, it is surely trivial. Let those nutters do what they want; at least it is not harmful!”
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6 Responses to Homeopathy: from bad to worse to ‘Dr’ Andrew Wakefield
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Well, that answers a question that I have pondered over for some time.
I have wondered whether use of homeopathy, providing an excuse to withdraw superfluous conventional treatment, might reduce the use of finite conventional medical resources.
An alternative scenario would be that users of homeopathy have a high propensity to use conventional services for their conditions and homeopathy is simply added to that use.
An even less generous interpretation would be that hypochondriacs suck up resources and giving them more resources to suck upon does not reduce their appetite.
Whichever is the more accurate description, it certainly does not look like the use of homeopathy could be justified financially even if we were able to tolerate it ethically.
I agree. For #3 that giving homepathy to hypochondriacs doesn’t reduce their appetite, I have often thought that giving placebos to them would be a losing battle. Unless you treat their psychological reasons for this you are just feeding the monster.
Does Mr Wakefield have a PhD?
I am unable to find his academic qualifications anywhere.
I see he was a ‘surgeon’ and presumably a Fellow of one of the surgical colleges. As such, it is traditional in the UK to use the appelation ‘Mr’.
Of course in the UK it is not illegal for anyone to describe themselves as ‘Dr’ – or ‘Lord’ (Lord Sutch); ‘Prince’ (Prince Roger Nelson) etc. Use of ‘Dr’ does however confer just a little hint at professional status which in Mr Wakefield’s case is no longer warranted.
It would be better to refer to him as ‘Former registered medical practitioner Mr Andrew Wakefield’.
Use of ‘Dr’ is a red flag that deception may be intended.
This will satisfy the homeopathists who complained about a lack of data underpinning attempts to shut down homeopathy on the NHS.
I say satisfy, what I actually mean is that they will studiously ignore it and carry on asserting that homeopathy saves money.
The important message is that both direct and indirect costs were included in the model. It’s easy to show homeopathy is cheaper if you only include the cost of the drugs. There is good evidence that improving compliance with orthodox drug treatment results in lower overall health care costs (eg fewer hospital admissions), let alone lower societal costs. So as you say because drugs work they are more cost-effective.
someone just tweeted about this:
Wakefield not a doctor, homeopathy not medicine – match made in heaven
I THINK THIS IS A BRILLIANT COMMENT