Modellversuch der Innungskrankenkasse Hamburg zu den Naturheilverfahren - Hom

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Complementary medicine an efficient element
for sustainable health budgets? Stefan N.
Willich Institute for Social Medicine,
Epidemiology and Health Economics Charité
University Medical Center Berlin,
Germany www.charite.de/epidemiologie
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Medicine from Descartes to Watson/Crick
19th Century 21th Century Medicine within
natural science Body/soul dualism Human as a
machine Repair mechanisms Principle of
causality We live forward but we understand
backward (William Jones)
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Complementary Medicine (alternative,
unconventional, holistic)

• Various approaches in theory and medical practise
• Encouragement of constitutional regulation
• Anthropological image of man
• Healing
• Somatic intervention
• Salutogenesis
• Development by illness

Willich et al., Dtsch Ärzteblatt
2004101A1314-1319
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Visits to Practitioners of Alternative Therapies
(USA 1990-1997)
1990
1997
Visit to All Primary Care Physicians
Visits to Practitioners of Alternative Therapies
Visit to All Primary Care Physicians
Visits to Practitioners of Alternative Therapies
Eisenberg DM et al., JAMA 19982801569-1575
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Utilization and Cost of Complementary and
Alternative Medicine in Germany

• Utilization of alternative medicine 70
• Natural remedies in the last 3 months 30-40
• Physicians with education in CAM 10
• Natural remedies (44 prescribed) 2 Bill. Euro
• Visits at physicians 2 Bill. Euro
• Private treatment / over the counter ca. 5 Bill.
  Euro

RKI 2001 Allensbach/Stat. Bundesamt 2002
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Frequency of Complementary Medicine Utilization
(12 Months)
Total (n1100) Men (n551) Women (n549)
Naturopathic treatment () 57 50 65
Chirotherapy () 14 13 15
Homeopathy () 15 10 20
Acupuncture () 9 6 11
TCM () 2 1 2
Ayurveda () 1 0,4 1
Anthroposophic treatment () 1 0,3 2
Härtel/Volger, Forsch Komplementärmed Klass
Naturheilkd 200411327-334
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Use of Alternative Therapies(108 Oncology
Patients)

• 23 of the patients planned to start an
  alternative therapy after completing their
  conventional treatment

Van der Weg and Streuli 2003
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Reasons for use of AT
Van der Weg and Streuli 2003
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Proportion of Alternative Medication
Prescriptions
Percentage of phytopharmaca
Percentage of homeopathica
IMS Health - Panel
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Results

• 196.518 Patients
• 65 women (age 49?14 years)
• 35 men (age 52?14 years)
• 10?3 Acupuncture treatments

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Diagnoses
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Osteoarthritis of the Knee (Gon-ART)
Witt et al. Lancet 2005366136-143
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Headache Days (Migrane-ART)
Linde et al. JAMA 20052932118-2125
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Comparison of Costs (Over 3 Months)
Total cost per patient 0-3 months after begin of
study
All. Rhinitis/ Asthma
Dysmenorrhea
Headache
Neck pain
Low back pain
Arthritis
Costs of Routine Treatment
Costs of Acupuncture
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Cost-Effectiveness-Analysis
International threshold values 30,000 GBP
50,000
ICER, Euro per Qaly gained
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Cost-effectiveness Acceptability Curve and
Sensitivity Analyses of Acupuncture in
Osteoarthritis Pain
Willich SN et al. submitted
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Adverse Events
261,897 completed treatments (with 10
sessions of acupuncture each)
no 91
minor 8.5
major 0.8 (3 cases of pneumothorax)
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Study Design

• Prospective, comparative, multicenter cohort
  study

Doctors
Homeopathic
Conventional Medicine
Patients
First treatment by doctor Age gt 16
years Diagnosis of chronic illness -
Headache - Low back pain - Depression -
Sleep disorders - Sinusitis
Witt C et al., Complement Ther Med 20051379-86
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Patients Rating of ComplaintsOverall Diagnoses
(Adjusted)

• Diagnoses
• Headache
• Low back pain
• Depression
• Sleep disorders
• Chron. Sinusitis

Homeopathy o Conventional
Witt C et al., Complement Ther Med 20051379-86
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Physicians Rating of ComplaintsOverall
Diagnoses (Adjusted)

• Diagnoses
• Headache
• Low back pain
• Depression
• Sleep disorders
• Chron. Sinusitis

Homeopathy o Conventional
Witt C et al., Complement Ther Med 20051379-86
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Total Costs Overall Diagnoses
Adjusted analysis Homöo/Schul pns Homöo
vor/nach plt0.001 Schul vor/nach plt0.001
Inpatient, outpatient treatment (incl.
homeopathy), drugs, aids to daily living,
sick-pay, physical therapy
Witt C et al., Complement Ther Med 20051379-86
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Kondratieff-Cycles
Basic Innovation Basic Innovation Basic Innovation Basic Innovation Basic Innovation Basic Innovation
Steam-engine Textile industry Steel Railway Electrical/ chemical engineering Automobile Petro-chemistry Information Technology Psycho-social Health
Major Application Major Application Major Application Major Application Major Application Major Application
Clothing Transport Mass consumption Individual mobility Globalization Communic. Health Education
1. Kondratieff 2. Kondratieff 3. Kondratieff 4. Kondratieff 5. Kondratieff 6. Kondratieff
1800 1850 1900 1950 1990 20XX
Nefiodow LA 2000
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Summary

• Widespread utilisation of complementary therapies
• Established study methodology applicable to
  complementary medicine
• Acupuncture in routine care clinical benefit and
  cost effective within common threshold
• Homeopathic treatment tends to be superior to
  conventional medicine at same cost
• Cooperation between complementary and
  conventional medicine urgently needed

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