The Clinical And Cost Effectiveness Of Acupuncture For Symptomatic IDO

Jenks J1, Smyth E1, Pakzad M H1, Hamid R1, Okrim J1, Greenwell T J1

Research Type

Clinical

Abstract Category

Overactive Bladder

Abstract 676
Non Discussion Abstracts
Scientific Non Discussion Abstract Session 36
Neuromodulation Detrusor Overactivity Voiding Diary Questionnaire
1. University College London Hospital
Links

Abstract

Hypothesis / aims of study
To assess the clinical effectiveness and cost effectiveness of acupuncture in the treatment of refractory symptomatic idiopathic detrusor overactivity.
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.
Concluding message
Acupuncture successfully treated 74.1% of the group with no incidence of drop out due to side effects. Responders had a significantly improved functional bladder capacity, day and night frequency and ICIQ-OAB  score. Patients with a lower functional capacity are more likely to obtain symptomatic benefit. 
However, it is the most costly of the three interventions reviewed and should remain a second line treatment in the management of IDO. Clinicians should be familiar with all treatment options for the management of IDO, to facilitate patients' choice of treatment that is most suitable to them and therefore most likely to be adhered to and deemed successful.
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Disclosures
Funding None Clinical Trial No Subjects Human Ethics not Req'd All participants were NHS patients, the patients were not randomised and there was no variation in treatment management plan from the norm. Additionally, acupuncture is safe and well tolerated form of neuromodulation Helsinki Yes Informed Consent Yes
27/03/2024 16:07:21