MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

A number of German health insurances are offering integrated care contracts for homeopathy (ICCHs) that cover the reimbursement of homeopathy. But the effectiveness and cost-effectiveness of these contracts are highly questionable. Now a team of German researchers evaluated the effectiveness and cost-effectiveness of treatment after an additional enrolment in an ICCH in a comparative, prospective, observational study (sponsored by the health insurance company Techniker Krankenkasse).

The participants in the ICCH (HOM group) were compared with matched (on diagnosis, sex and age) insured individuals (CON group) who received usual care alone. Those insured with either

  • migraine or headache,
  • allergic rhinitis,
  • asthma,
  • atopic dermatitis,
  • depression

were included. Primary effectiveness outcomes were the baseline adjusted scores of diagnosis-specific questionnaires (e.g. RQLQ, AQLQ, DLQI, BDI-II) after 6 months. Primary cost-effectiveness endpoints were the baseline adjusted total costs from an insurer perspective in relation to the achieved quality-adjusted life years (QALYs). Costs were derived from health claims data and QALYs were calculated based on SF-12 data.

Data from 2524 participants (1543 HOM group) were analysed. The primary effectiveness outcomes after 6 months were statistically significant in favour of the HOM group for:

  • migraine or headache (Δ = difference between groups, days with headache: – 0.9, p = 0.042),
  • asthma (Δ-AQLQ(S): + 0.4, p = 0.014),
  • atopic dermatitis (Δ-DLQI: – 5.6, p ≤ 0.001),
  • depression (Δ-BDI-II: – 5.6, p ≤ 0.001).

Only the BDI-II differences reached the minimal clinically important difference.

For all diagnoses, the adjusted mean total costs over 12 months were higher in the HOM group from an insurer perspective, with

  • migraine or headache,
  • atopic dermatitis,
  • depression

suggesting cost-effectiveness in terms of additional costs per QALY gained.

The authors concluded that after an additional enrolment in the ICCH, the treatment of participants with depression showed minimally clinically relevant improvements. From an insurer perspective, treatment with an ICCH enrolment resulted in higher costs over all diagnoses but seemed to be cost-effective for migraine or headache, atopic dermatitis and depression according to international used threshold values. Based on the study design and further limitations, our findings should be considered cautiously and no conclusions regarding the effectiveness of specific treatment components can be made. Further research is needed to overcome limitations of this study and to confirm our findings.

Normally, I find newly published studies by conducting Medline searches. This one, I found because the insurance company in question, the Techniker Krankenkasse, is already using it for their advertising. No wonder – this is not a scientific study but a clever marketing coup!

THE RESULTS OF THIS ‘STUDY’ WERE CLEAR, EVEN BEFORE THE FIRST PATIENT WAS RECRUITED. 

Imagine you are a patient with one of the 5 conditions listed above, and you evidently like homeopathy – so much so that you approach your insurance and ask to get cover for homeopathy at extra cost to yourself. These were the patients of experimental group. They were compared to patients who could not care less about homeopathy and thus did not get this extra cover.

Who do you think claims to feel better in a self-administered questionnaire?

Is there anyone surprised at the findings of this study?

Well, actually I am a little surprised. Not that the results were positive, but that the results were not more positive. With such a monsterous bias built in the ‘study’, I would have expected much larger differences.

And I am surprised about something else too: how come BMC Health Services Research publishes such promotional marketing masquerading as scientific research?

This clever marketing coup can in no way determine the effectiveness of homeopathy. For that, we need RCTs of which there are already plenty; and we all know what they show: the effects of homeopathy are indistinguishable from those of placebo.

This means there is no proven effectiveness. And what did the director of NICE England once tell me?

WHERE THERE IS NO EFFECTIVENESS, THERE CAN ALSO BE NO COST-EFFECTIVENESS!

8 Responses to Effectiveness and cost-effectiveness of homeopathy. A new study from Germany

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories