Study design, materials and methods
This study was carried out over a 24 month period. Thirty patients having acupuncture for symptomatic refractory idiopathic detrusor overactivity (IDO) were prospectively evaluated. A single medical acupuncturist treated all patients. Treatments consisted of one 45 minute session, at weekly intervals for 6 weeks. All patients completed a 3-day frequency volume chart, EQ-5D & ICIQ-OAB quality of life questionnaires and patient reported outcome measure (PROM) prior to and 2 weeks after treatment. Outcome measures were assessed post treatment and compared for responders and non-responders. A cost analysis was performed comparing acupuncture with pharmacotherapies and conservative management. A cost comparison was made between all treatment options at both six weeks and six months. Statistical analysis was by Student's paired T−Test and Mann−Whitney U test.
Results
Twenty seven patients completed 6 weeks of treatment (6 male, 21 female). The therapy was well tolerated in all patients. Overactive bladder (OAB) symptoms were completely resolved in 14.8%, significantly improved in 59.3% and unchanged in 25.9%. No patients reported any adverse events. There was a significant reduction in ICIQ-OAB, daytime and night time frequency. We found a significant increase in functional bladder capacity. However, there was no change in overall quality of life as assessed by EQ-5D and the general health thermometer. In relation to cost, conservative methods are the most cost effective treatment option for OAB, followed by pharmacotherapy.
Interpretation of results
Overall 20 (74.1%) patients had a successful response, 4 (14.8%) are 'cured' and have discontinued treatment, while 16 (59.3%) continue top-up treatments once per month. In the subgroup analysis, the responders (n=20) had significantly smaller pre-treatment functional bladder capacities which statistically increased post treatment. Additionally, they had significant reduction in day and night time frequency post treatment. There was no demonstrable maximal pre-treatment functional capacity above which no one responded. The responders had a statistical improvement in ICIQ-OAB scores. With regard to cost, at six months acupuncture therapy demonstrated a 50% increase in associated costs when compared to maximal pharmacotherapy.