Cost-Effectiveness of Pharmacopuncture Versus Conventional Acupuncture for Insomnia: An RCT-Based Economic Evaluation with a Markov Model

초록

IntroductionPharmacopuncture, which combines traditional acupuncture with herbal medicine, may offer synergic therapeutic effects for insomnia management; however, evidence on its economic value remains limited. This study evaluates the cost-effectiveness of pharmacopuncture for insomnia disorder compared with other acupuncture modalities in South Korea. MethodsTwo Markov models were developed from a healthcare system perspective to assess the short- and long-term cost-effectiveness of pharmacopuncture. The models included four levels of insomnia severity based on the Insomnia Severity Index (ISI). Transition probabilities, medical costs, and utility weights were derived from a pragmatic randomized controlled trial (KCT0006803). A 4-week cycle length was applied to stimulate 100 participants with moderate-to-severe insomnia. The short- and long-term models employed 8- and 24-week time horizons, respectively. Effective outcomes included the proportion of remission (ISI < 8) and quality-adjusted life-years (QALYs). ResultsPharmacopuncture incurred an incremental cost of KRW 368,000 (USD 270) per additional remission achieved over 8 weeks. Long-term analysis showed an incremental cost-effectiveness ratio of KRW 16,940,000 (USD 12,600) per QALY. Sensitivity analyses revealed that cost-effectiveness was sensitive to pharmacopuncture pricing. ConclusionPharmacopuncture can be considered cost-effective if decision-makers accept an additional cost of KRW 400,000 (approximately USD 280) per responder over 2 months. At a willingness-to-pay threshold of KRW 27,660,000 (approximately USD 21,740), pharmacopuncture is a cost-effective option for managing insomnia compared with other acupuncture modalities.

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