Anthroposofic Medicine - Effectiveness, utility, costs, safety

Anthroposophic Medicine Effectiveness, Utility, Costs Safety Gunver Kienle MD*, Helmut Kiene MD*, Hans Ulrich Albonico, MD** *) Reviewers, Institute for Applied Epistemology and Medical Methodology IFAEMM, Schauinslandstrasse 6, DE-70189 Bad Krozingen. E-Mail: gunver.kienle@ifaemm.de, helmut.kiene@ifaemm.de **) Expert for research in the field of anthroposophic medicine, Vereinigung Anthroposophisch Orientierter Ärzte in der Schweiz (VAOÄS), Bernstrasse 13, CH-3550 Langnau, E-Mail: albolem@hotmail.com ©2006 by Schattauer Verlag, Stuttgart-New York (Schattauer GmbH, Hölderlinstrasse3, DE-70174, Stuttgart, Germany). ISBN-10: 3-7945-2495-0 ISBN-13: 978-3-7945-2495-2 This Health Technology Assessment (HTA) report (http://www.bag.admin.ch www.ifaemm.de) was commissioned by the Swiss Federal Social Insurance Office and produced as part of the national Complementary Medicine Evaluation Programme (PEK). The presented review is an update of this HTA-report, providing an overview of the available scientific literature on the effectiveness, utility, costs and safety of anthroposophic medicine. Content • Introduction • Presentation of the special aspects of anthroposophic medicine, in fundamental research and clinical practice • Discussion of the methodology • Material and methods • Results with regard to effectiveness, utility, costs and safety • Discussion • Comment on published criticism regarding studies with mistletoe • Catalogue of case presentations and literature not used for the analysis etc. 1/4 Studies Single case studies (not analysed in the review): 2090 studies Clinical studies suitable for analysis: 195 studies Systematic reviews in 4 "Domains": 127 studies Further studies "Appendix": 68 studies Design of the 195 studies • Prospective comparative design: 40 studies o RCTs: 18 studies (5 blinded) o Matched-Pair: 4 studies (3 blinded) • Retrospective comparative design: 45 studies • Cohort-study design: 110 studies o prospective: 62 studies o retrospective: 43 studies o other: 5 studies Results: effectiveness 127 Studies in 4 “Domains” • Anthroposophic Medicine studied as a therapeutic system for various disorders (including comparisons of systems) 8 studies • Treatment of pain or treatments of wounds with anthroposophic medicines 18 studies including 3 RCTs • Non-pharmacologic treatment of various disorders 5 studies and 3 extra-analyses • Anthroposophic mistletoe treatment of cancer 96 studies including 15 RCTs 68 studies further studies ("Appendix") • Chronic hepatitis B or C 10 studies • Neurological or psychiatric disorders 7 studies • Gynaecology and Obstetrics 6 studies • Acute infections (upper respiratory tract, ear, eyes, gastrointestinal) 18 studies • Circulatory diseases 6 studies 2/4 • Thyroid diseases 4 studies • Pulmonary diseases (sarcoidosis) 6 studies • Other disorders 11 studies Results: summary 4 Domains and Appendix 195 studies were analysed: • 186 studies had positive results for the AM-Group (similar or better result compared to conventional therapy regarding at least 1 clinical parameter). • 8 studies showed neither positive nor negative results. • 1 study showed a negative trend. • The practical relevance was throughout the studies high. • The quality of the studies varied from very to good to very poor (in particular the retrospective comparative studies). • The satisfaction of the patients was high. The positive results were still relevant, if the analysis was restricted to the qualitatively good studies. Results: utility Users of anthroposophic medicine: • patients of basic national health care and patients with a special interest • especially women, patients aged 30-50 years and children • high level of education • often after complications or ineffectiveness of conventional treatment • interest in comprehensive treatment and active engagement • high degree of patient-satisfaction with AM Results: safety • 2 carefully designed safety analyses, phase I-studies, questionnaires within the framework of clinical studies, database, case reports • good compliance • 0.005% of the applications of medicines caused slight side effects • In general, AM had higher compliance and less side effects, if compared to conventional medicine. 3/4 Results: costs • Within the framework of PEK the cost analysis was done in general and not differentiated for the different therapeutic approaches. • Only very few cost analyses are available specifically for anthroposophic medicine. • 1 German study, which was performed in 141 offices of anthroposophic medical doctors, including 898 patients treated with anthroposophic medicines for chronic diseases showed less costs during the study year, if compared to those during the year before enrolling into the study (3.484 Euro vs. 3.637 Euro). • The patients treated with anthroposophic medicine had less costs for medicines and less referrals to hospital care, although the severity of their disorders was similar or even worse, if compared to the conventionally treated group. Conclusions: • Anthroposophic medical therapies result in favourable clinical outcomes according to the large majority of the reviewed studies. This conclusion also holds when limited to studies with good quality. • Anthroposophic medicine is used by both patients within ordinary health care provision and by patients with a special interest for this therapeutic approach. • Anthroposophic medical therapies are satisfactory to the patients and safe. • Anthroposophic medical therapies may also be cost effective through lower rates of referrals to hospital-treatment and lower costs for medication particularly in chronic diseases. 4/4