Explore: The Journal of Science and Healing
Volume 6, Issue 2 , Pages 86-99 , March 2010

Health and Medical Economics Applied to Integrative Medicine

  • Kenneth R. Pelletier, PhD, MD(hc)

      Affiliations

    • University of Arizona School of Medicine, Tucson, AZ, and University of California (UCSF) School of Medicine, San Francisco, CA
    • ,
  • Patricia M. Herman, ND, PhD

      Affiliations

    • Evaluation, Research and Development Unit, University of Arizona, Tucson, AZ
    • ,
  • R. Douglas Metz, DC

      Affiliations

    • American Specialty Health (ASH)
    • ,
  • Craig F. Nelson, DC

      Affiliations

    • American Specialty Health (ASH)

References 

  1. Loeppke R. The value of health and the power of prevention. Int J Health Plan Manag. 2008;1:95–108
  2. Thorpe KE. Factors accounting for the rise in health care spending in the United States: the role of rising disease prevalence and treatment intensity. Public Health. 2006;120:1002–1007
  3. World Economic Forum. Working toward wellness: the business rationale. Price Waterhouse Cooper Web site. http://www.pwc.com/extweb/pwcpublications.nsf/docid/6EE4249D9FCF6AD F85257415001A3EE8/$file/WTW_Business_Rationale.pdfAccessed May 5, 2009
  4. Workforce Health and Productivity Summit consensus statements, American College of Occupational and Environmental Medicine and the Integrated Benefits Institute. American College of Occupational and Environmental Medicine Web site. 2008;http://acoem.com/uploadedFiles/About_ACOEM/Press_Releases/Summit%20 Background%20and%20Consensus%20Statements%20Draft%2011-25–08%20FINAL.pdfAccessed December 7, 2008
  5. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997. JAMA. 1998;280:1569-1515
  6. Legorreta AP, Metz RD, Nelson CF, Ray S, Chernicoff HO, Dinubile NA. Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs. Arch Intern Med. 2004;164:1985–1992
  7. Metz RD, Nelson CF, LaBrot T, Pelletier KR. Chiropractic care: Is it substitution care or add-on care in corporate medical plans?. J Occup Environ Med. 2004;46:847–855
  8. Nelson CF, Metz RD, LaBrot T. Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain. J Manipulative Physiol Ther. 2005;28:564–569
  9. Sarnat RL, Wintersteri J, Cambron JA. Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3-year update. J Manipulative Physiol Ther. 2007;30:263–269
  10. Lee JA, Shepard DS. Costs of Cardiac Rehabilitation and Enhanced Lifestyle Modification Programs. J Cardiopulm Rehabil Prev. 2009;29:348–357
  11. Ornish D. Avoiding revascularization with lifestyle changes: the multicenter lifestyle demonstration project. Am J Cardiol. 1998;82:72T–76T
  12. The Diabetes Prevention Program. The diabetes prevention program (DPP), description of lifestyle intervention. Diabetes Care. 2002;25:2165–2171
  13. Herman WH, Hoerger TJ, Brandle M, et al. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005;142:323–332
  14. The Diabetes Prevention Program. Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Diabetes Care. 2003;26:2518–2523
  15. Eddy DM, Schlessinger L, Kahn R. Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes [summary for patients]. Ann Intern Med. 2005;143:I22;Ann Intern Med. 2005;143:251-264
  16. White AR, Ernst E. Economic analysis of complementary medicine: a systematic review. Complement Ther Med. 2000;8:111–118
  17. Herman PM, Craig BM, Caspi O. Is complementary and alternative medicine (CAM) cost-effective? (A systematic review). BMC Complement Altern Med. 2005;5:11
  18. Hulme C, Long AF. Square pegs and round holes? (A review of economic evaluation in complementary and alternative medicine). J Altern Complement Med. 2005;11:179–188
  19. Bornhoft G, Wolf U, von Ammon K, et al. Effectiveness, safety and cost-effectiveness of homeopathy in general practice - summarized health technology assessment. Forsch Komplementarmed. 2006;13(suppl 2):19–29
  20. Canter PH, Coon JT, Ernst E. Cost-effectiveness of complementary therapies in the United Kingdom–a systematic review. Evid Based Complement Altern Med. 2006;3:425–432
  21. Kennedy DA, Hart J, Seely D. Cost effectiveness of natural health products: a systematic review of randomized clinical trials. Evid Based Complement Altern Med. 2007;6:297–304
  22. Maciosek MV, Coffield AB, Edwards NM, Flottemesch TJ, Goodman MJ, Solberg LI. Priorities among effective clinical preventive services: results of a systematic review and analysis. Am J Prev Med. 2006;31:52–61
  23. Goetzel RZ, Roemer EC, Liss-Levinson RC, Samoly DK. Workplace health promotion: policy recommendations that encourage employers to support health improvement programs for their workers (A Prevention policy paper commissioned by Partnership for Prevention). www.hss.state.ak.us/healthcommission/200905/worksite_health.pdfDecember 2008;Accessed February 7, 2010
  24. Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281:613–620
  25. Stewart S, Marley JE, Horowitz JD. Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study. Lancet. 1999;354:1077–1083
  26. Wallack SS. Disease management program reduces hospital days for chronic renal disease patients. Grant Results. Robert Wood Johnson Foundation. http://www.rwjf.org/reports/grr/032061.htmAccessed February 2, 2009
  27. Goetzel RZ, Ozminkowski RJ, Baase CM, Billotti GM. Estimating the return on investment from changes in employee health risks on the Dow Chemical Company's health care costs. J Occup Environ Med. 2005;47:759–764
  28. Goetzel RZ, Ozminkowski RJ, Villagra VG, Duffy J. Return on investment in disease management: a review. Health Care Financ Rev. 2005;26:1–19
  29. Coleman EA, Grothaus LC, Sandhu N, Wagner EH. Chronic care clinics: a randomized controlled trial of a new model of primary care for frail older adults. J Am Geriatr Soc. 1999;47:775–783
  30. Lorig KR, Ritter P, Stewart AL, et al. Chronic disease self-management program: 2 year health status and health care utilization outcomes. Med Care. 2001;39:1217–1223
  31. Thomas KJ, MacPherson H, Ratcliffe J, et al. Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health Technol Assess. 2005;9:1–109iii-iv, ix-x
  32. Liguori A, Petti F, Bangrazi A, et al. Comparison of pharmacological treatment versus acupuncture treatment for migraine without aura-analysis of socio-medical parameters. J Tradit Chin Med. 2000;20:231–240
  33. Brown AP, Kennedy AD, Torgerson DJ, Campbell J, Webb JA, Grant AM. The OMENS trial: opportunistic evaluation of musculo-skeletal physician care among orthopaedic outpatients unlikely to require surgery. Health Bull. 2001;59:198–210
  34. Lindall S. Is acupuncture for pain relief in general practice cost-effective?. Acupunct Med. 1999;17:97–101
  35. Herman PM, Szczurko O, Cooley K, Mills EJ. Cost-effectiveness of naturopathic care for chronic low back pain. Altern Ther Health Med. 2008;14:32–39
  36. Ballegaard S, Borg E, Karpatschof B, Nyboe J, Johannessen A. Long-term effects of integrated rehabilitation in patients with advanced angina pectoris: a nonrandomized comparative study. J Alternative Compl Med. 2004;10:777–783
  37. Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ. 2003;326:911–917
  38. Burton AK, Tillotson KM, Cleary J. Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. Eur Spine J. 2000;9:202–207
  39. Burton WN, Conti DJ. Disability management: corporate medical department management of employee health and productivity. J Occup Environ Med. 2000;42:1006–1012
  40. Almog G, Lamond P, Gosselin G. Effects of chiropractic care on spinal symptomatology among professional drivers: a pilot study. Clin Chiropr. 2004;7:114–119
  41. Folsom BL, Holloway RW. Chiropractic care of Florida workers compensation claimants: access, costs, and administrative outcome trends from 1994 to 1999. Top Clin Chiropr. 2002;9:P33–P53
  42. Stowell AW, Gatchel RJ, Wildenstein L. Cost-effectiveness of treatments for temporomandibular disorders: biopsychosocial intervention versus treatment as usual. J Am Dent Assoc. 2007;138:202–208
  43. Ryan M, Gervitz R. Biofeedback-based psychophysiological treatment in a primary care setting: an initial feasibility study. Appl Psycholphysiol Biofeedback. 2004;29:79–93
  44. Singh NN, Lancioni GE, Winton ASW, Singh AN, Adkins AD, Singh J. Clinical and benefit--cost outcomes of teaching a mindfulness-based procedure to adult offenders with intellectual disabilities. Behav Modif. 2008;32:622–637
  45. Singh NN, Lancioni GE, Winton ASW, et al. Individuals with mental illness can control their aggressive behavior through mindfulness training. Behav Modif. 2007;31:313–328
  46. Roth B, Stanley TW. Mindfulness-based stress reduction and healthcare utilization in the inner city: preliminary findings. Altern Ther Health Med. 2002;8:60–6264-66
  47. Herron RE, Hillis SL. The impact of the transcendental meditation program on government payments to physicians in Quebec: an update. Am J Health Promo. 2000;14:284–291
  48. Tusek DL, Cwynar R, Cosgrove DM. Effect of guided imagery on length of stay, pain and anxiety in cardiac surgery. J Cardiovasc Manag. 1999;10:22–28
  49. van Dixhoorn JJ, Duivenvoorden HJ. Effect of relaxation therapy on cardiac events after myocardial infarction: a 5-year follow-up study. J Cardiopulm Rehabil. 1999;19:178–185
  50. Frei H, Thurneysen A. Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution?. Br Homeop J. 2001;90:180–182
  51. Jain A. Does homeopathy reduce the cost of conventional drug prescribing? (A study of comparative prescribing costs in general practice). Homeopathy. 2003;92:71–76
  52. Trichard M, Chaufferin G, Nicoloyannis N. Pharmacoeconomic comparison between homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in children [comment]. Homeopathy. 2005;94:3–9
  53. Chrubasik S, Kunzel O, Black A, Conradt C, Kerschbaumer F. Potential economic impact of using a proprietary willow bark extract in outpatient treatment of low back pain: an open non-randomized study. Phytomedicine. 2001;8:241–251
  54. Dobson A, DaVanzo J, Consunji M, et al. A Study of the Cost Effects of Daily Multivitamins for Older Adults. Falls Church, Va: The Lewin Group, Inc; 2004:30. http://www.lewin.com/content/publications/2833.pdfAccessed February 2, 2010
  55. Braga M, Gianotti L, Vignali A, Schmid A, Nespoli L, Di Carlo V. Hospital resources consumed for surgical morbidity: effects of preoperative arginine and omega-3 fatty acid supplementation on costs. Nutrition. 2005;21:1078–1086
  56. Braga M, Gianotti L. Preoperative immunonutrition: cost-benefit analysis. JPEN J Parenter Enteral Nutr. 2005;29(1 suppl):S57–S61
  57. Smedley F, Bowling T, James M, et al. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care. Br J Surg. 2004;91:983–990
  58. Norris W, Kunzelman KS, Bussell S, Rohweder L, Cochran RP. Potassium supplementation, diet vs pills: a randomized trial in postoperative cardiac surgery patients. Chest. 2004;125:404–409
  59. Lassen KO, Olsen J, Grinderslev E, Kruse F, Bjerrum M. Nutritional care of medical inpatients: a health technology assessment. BMC Health Serv Res. 2006;6:7
  60. Defechereux T, Meurisse M, Hamoir E, Gollogly L, Joris J, Faymonville ME. Hypnoanesthesia for endocrine cervical surgery: a statement of practice. J Altern Complement Med. 1999;5:509–520
  61. Meurisse M, Defechereux T, Hamoir E, et al. Hypnosis with conscious sedation instead of general anaesthesia? (Applications in cervical endocrine surgery). Acta Chir Belg. 1999;99:151–158
  62. Lang EV, Rosen MP. Cost analysis of adjunct hypnosis with sedation during outpatient interventional radiologic procedures. Radiology. 2002;222:375–382
  63. Montgomery GH, Bovbjerg DH, Schnur JB, et al. A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. J Natl Cancer Inst. 2007;99:1304–1312
  64. Boon H, MacPherson H, Fleishman S, et al. Evaluating complex healthcare systems: a critique of four approaches. Evid Based Complement Altern Med. 2007;4:279–285
  65. Herman PM, Sherman KJ, Erro JH, Cherkin DC, Milliman B, Adams LA. A method for describing and evaluating naturopathic whole practice. Altern The Health Med. 2006;12:20–28
  66. Willich SN, Reinhold T, Selim D, Jena S, Brinkhaus B, Witt CM. Cost-effectiveness of acupuncture treatment in patients with chronic neck pain. Pain. 2006;125:107–113
  67. Witt CM, Jena S, Selim D, et al. Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol. 2006;164:487–496
  68. Reinhold T, Witt CM, Jena S, Brinkhaus B, Willich SN. Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain. Eur J Health Econ. 2008;9:209–219
  69. Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008;198:166;e1-e8
  70. Witt CM, Reinhold T, Jena S, Brinkhaus B, Willich SN. Cost-effectiveness of acupuncture treatment in patients with headache. Cephalalgia. 2008;28:334–345
  71. Vickers AJ, Rees RW, Zollman CE, et al. Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis. Health Technol Assess. 2004;8:iii
  72. Wonderling D, Vickers AJ, Grieve R, McCarney R. Cost effectiveness analysis of a randomized trial of acupuncture for chronic headache in primary care. BMJ. 2004;328:747
  73. Paterson C, Ewings P, Brazier JE, Britten N. Treating dyspepsia with acupuncture and homeopathy: reflections on a pilot study by researchers, practitioners and participants. Complement Ther Med. 2003;11:78–84
  74. Ratcliffe T, Thomas KJ, MacPherson H, Brazier J. A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis. BMJ. 2006;333:626
  75. Samueli Institute. Knowledge center for optimal healing environments. http://www.siib.org/research/research-home/optimal-healing.htmlAccessed February 5, 2009
  76. Stothers L. A randomized trial to evaluate effectiveness and cost-effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol. 2002;9:1558–1562
  77. Rein DB, Saaddine JB, Wittenborn JS, et al. Cost-effectiveness of vitamin therapy for age-related macular degeneration. Ophthalmology. 2007;114:1319–1326
  78. Martikainen JA, Ottelin A-M, Kiviniemi V, Gylling H. Plant stanol esters are potentially cost-effective in the prevention of coronary heart disease in men: Bayesian modelling approach. Eur J Cardiovasc Prev Rehabil. 2007;14:265–272
  79. Whitmer RW, Pelletier KR, Anderson DR, Basse CM, Frost GJ. A wake-up call for corporate America. J Occup Environ Med. 2003;45:916–925
  80. Pelletier KR. A review and analysis of the clinical and cost effectiveness studies of comprehensive health promotion and disease management worksite programs at the worksite: Update VII: 2004-2008. J Occup Environ Med. 2009;51:822–837Submitted by request from the “Database of Abstracts of Reviewers of Effects” (DARE) database. University of York, York, United Kingdom: June 17, 2009
  81. American College of Occupational and Environmental Medicine. Healthy workforce/healthy economy: the role of health, productivity, and disability management in addressing the nation's health care crisis. J Occup Environ Med. 2009;51:114–119
  82. Goetzel RZ, Ozminkowski RJ. The health and cost benefits of worksite health promotion programs. Ann Rev Public Health. 2008;29:303–323
  83. Goetzel RZ, Juday TR, Ozminkowski RJ. What's the ROI? (A systematic review of return on investment (ROI) studies of corporate health and productivity management initiatives). AWHP's Worksite Health. 1999;6:12–21
  84. Aldana SG, Pronk NP. Health promotion programs, modifiable health risks, and employee absenteeism. J Occup Environ Med. 2001;43:36–46
  85. Chapman LS. Meta-evaluation of worksite health promotion economic return studies. Am J Health Promot. 2005;19:1–11
  86. Pelletier KR. A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VI 2000–2004. J Occup Environ Med. 2005;47:1051–1058Reprinted in: Quick J, Tetrick L, eds. Handbook of Occupational Health Psychology. 2nd ed. Washington, DC: American Psychological Association: 2007.
  87. Milken Institute Study. http://www.milkeninstitute.orgAccessed February 7, 2010
  88. Devol R, Bedroussian A. An unhealthy America: The economic burden of chronic disease. Santa Monica: Milken Institute; 2007;
  89. Kimbrough K, Pelletier KR, Loa L, Talamonti WJ, Berman B. An integrative medicine intervention in a Ford Motor Company assembly plant. J Occup Environ Med. 2010;[in press]
  90. American College of Occupational and Environmental Medicine. Preventing needless work disability by helping people stay employed. [serial online] J Occup Environ Med. 2006;48:972–987http://www.acoem.org/guidelines.aspx?id=566Accessed February 7, 2010
  91. American Medical Association. Correct Procedural Terminology: CPT 2008 Data Files. Chicago, Ill: American Medical Association; 2008;
  92. American Medical Association. Physician. In: International Classification of Diseases, Ninth Revision, Clinical Modification. Vols 1 and 2:Chicago, Ill: American Medical Association; 2008;
  93. International Classification of Diseases, 10th Revision, Clinical Modification. http://apps.who.int/classifications/apps/icd/icd10onlineAccessed February 7, 2010
  94. ABC Coding Solutions. ABC Coding Manual for Integrative Health Care. 11th ed.. Albuquerque, NM: ABC Coding Solutions; 2009;

 This commissioned paper received funding from the Institute of Medicine in connection with the Summit Meeting on Integrative Medicine. The responsibility for the content of this paper rests with the authors alone and does not necessarily represent the views or endorsement of the Institute of Medicine or the National Academy of Sciences.

PII: S1550-8307(09)00414-5

doi: 10.1016/j.explore.2009.12.009

Explore: The Journal of Science and Healing
Volume 6, Issue 2 , Pages 86-99 , March 2010

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