Complementary and alternative medicine costs - a systematic literature review

Objective: The aim of this literature review, performed within the framework of the Swiss governmental Program of Evaluation of Complementary Medicine (PEK), was to investigate costs of complementary and alternative medicine (CAM). Materials and Methods: A systematic literature search was conducted in 11 electronic databases. All retrieved titles and reference lists were also hand-searched. Results: 38 publications were found: 23 on CAM of various definitions (medical and non-medical practitioners, over-the-counter products), 13 on homeopathy, 2 on phytotherapy. Studies investigated different kinds of costs (direct or indirect) and used different methods (prospective or retrospective questionnaires, data analyses, cost-effectiveness models). Most studies report 'out of pocket' costs, because CAM is usually not covered by health insurance. Costs per CAM-treatment / patient / month were AUD 7-66, CAD 250 and GBP 13.62 +/- 1.61. Costs per treatment were EUR 205 (range: 15-1,278), USD 414 +/- 269 and USD 1,127. In two analyses phytotherapy proved to be cost-effective. One study revealed a reduction of 1.5 days of absenteeism from work in the CAM group compared to conventionally treated patients. Another study, performed by a health insurance company reported a slight increase in direct costs for CAM. Costs for CAM covered by insurance companies amounted to approximately 0.2-0.5% of the total healthcare budget (Switzerland, 2003). Publications had several limitations, e.g. efficacy of therapies was rarely reported. As compared to conventional patients, CAM patients tend to cause lower costs. Conclusion: Results suggest lower costs for CAM than for conventional patients, but the limited methodological quality lowers the significance of the available data. Further well-designed studies and models are required.

Use of complementary medicine in Switzerland

Within the framework of the Swiss governmental Program of Evaluation of Complementary Medicine (PEK) we assessed the prevalence, use, perceived effectiveness and appreciation of complementary medicine (CAM) in Switzerland, according to published surveys. Materials and Methods: Search was performed through electronic databases, by hand-searching and by contacting experts at universities, hospitals, health insurances, patient organizations and pharmaceutical companies. Results: Surveys were carried out among the general population (40%), physicians (20%), hospitalized patients (30%) and obstetric institutions (5%). The number of publications increased strongly between 1981 and 2004. The mean +/- SD prevalence (use) of CAM is 49 +/- 22% and varies depending on the survey's topic and the population group interviewed. The acceptance, appreciation or demand for CAM among individuals specifically interviewed on CAM is 91 +/- 6%. When asked about favored general improvements in healthcare, 6.5% of the individuals spontaneously mentioned CAM. CAM therapies are considered to be effective by the majority of CAM users and by about 40% of cancer patients using CAM. Approximately 50% of the population stated a preference for hospitals that also provide CAM. 85% of the population wishes the costs for CAM to be covered by the basic health insurance. Conclusion: Approximately half of the Swiss population has used CAM. CAM treatment is considered to be effective by the majority of CAM users. About 50% of the population would prefer hospitals that also provide CAM therapies and the majority of the population wishes the cost for CAM therapies to be covered by basic health insurance.

Patients motives for choosing a physician: Comparison between conventional and complementary medicine in Swiss primary care

Background The study is part of a nationwide evaluation of complementary and alternative medicine (CAM) in primary care in Switzerland. The Objective was to identify patients' expectations and reasons governing the choice of complementary medicine compared with conventional primary care (CONV). Methods The data were derived from the PEK study (Programm Evaluation Komplementärmedizin), which was conducted in 2002–2003 with 7879 adult patients and parents of 1291 underage patients, seeking either complementary (CAM) or conventional (CONV) primary care. The study was performed as a cross-sectional survey. The respondents were asked to document their (or their children's) self-perceived health status, reasons governing their choice, and treatment expectations. Physicians were practicing conventional medicine and/or complementary methods (homeopathy, anthroposophic medicine, neural therapy, and traditional Chinese medicine). Reasons governing the choice of physician were evaluated on the basis of a three-part classification (physician-related, procedure-related, and pragmatic/other reasons) Results and Discussion Patients seeing CAM physicians tend to be younger and more often female. CAM patients referred to procedure-related reasons more frequently, whereas pragmatic reasons dominated among CONV patients. CAM respondents expected fewer adverse side effects compared to conventional care patients. Conclusion The majority of alternative medicine users appear to have chosen CAM mainly because they wish to undergo a certain procedure; additional reasons include desire for more comprehensive treatment, and expectation of fewer side-effects.

[Complementary and alternative medicine in primary care in Switzerland]

OBJECTIVE: This study investigated the current supply of complementary and alternative medicine (CAM) in Swiss primary care. Information was collected on physicians' qualifications in CAM, frequency of patients' demand for CAM, physicians' supply and temporal resources for CAM as well as physicians' referrals to CAM. MATERIAL AND METHODS: 750 (500 German-speaking and 250 French-speaking) randomly selected Swiss female and male primary care physicians were asked to complete a questionnaire (response rate 50.4%). Sociodemographic data on professional training, place of residence, and sex were used to calculate a weighting factor to correct the responders' data in the analysis accordingly. RESULTS: 14.2% of the physicians were qualified in at least one CAM discipline. Around 30% (95% confidence interval 25.4-34.6%) of the physicians were asked for CAM by their patients more than once a week. Homeopathy and phytotherapy were the most frequently offered therapies, followed by traditional Chinese medicine (TCM)/acupuncture. 62.5% (57.6-67.4%) of the physicians refer their patients to CAM. Most patients were referred to TCM/acupuncture. Of the 37.2% (32.6-42.4%) of the physicians who do not refer their patients to CAM, around 40% (35.1-44.9%) offer it themselves. CONCLUSION: About three quarters of the physicians offer CAM themselves or refer their patients to CAM treatments. CAM is very important in primary medical care in Switzerland. Clear regulations for CAM are required in order to ensure a high quality in care.

[Role of complementary medicine in type 1 diabetes mellitus in two Swiss centres]

Insulin replacement is the only effective treatment of type 1 Diabetes mellitus (T1DM). Nevertheless, many complementary treatments are in use for T1DM. In this study we assessed by questionnaire that out of 342 patients with T1DM, 48 (14%; 13.4% adult, 18.5% paediatric; 20 male, 28 female) used complementary medicine (CM) in addition to their insulin therapy. The purpose of the use of CM was to improve general well-being, ameliorate glucose homeostasis, reduce blood glucose levels as well as insulin doses, improve physical fitness, reduce the frequency of hypoglycaemia, and control appetite. The modalities most frequently used are cinnamon, homeopathy, magnesium and special beverages (mainly teas). Thus, good collaboration between health care professionals will allow optimal patient care.

A complementary radiographic projection of the equine temporomandibular joint

The complexity of the equine skull makes the temporomandibular joint a difficult area to evaluate radiographically. The goal of this study was to determine the optimal angle for a complementary radiographic projection of the equine temporomandibular joint based on a computed tomography (CT) cadaver study. CT was performed on six equine cadaver heads of horses that were euthanized for other reasons than temporomandibular joint disease. After the CT examination, 3D reconstruction of the equine skull was performed to subjectively determine the angle for a complementary radiographic projection of the temporomandibular joint. The angle was measured on the left and right temporomandibular joint of each head. Based on the measurements obtained from the CT images, a radiographic projection of the temporomandibular joint in a rostra-145 degrees ventral-caudodorsal oblique (R45 degrees V-CdDO) direction was developed by placing the X-ray unit 30 degrees laterally, maintaining at the same time the R45 degrees V-CdDO angle (R45 degrees V30 degrees L-CdDLO). This radiographic projection was applied to all cadaver heads and on six live horses. In three of the live horses abnormal findings associated with the temporomandibular joint were detected. We conclude that this new radiographic projection of the temporomandibular joint provides superior visualization of the temporomandibular joint space and the articular surface of the mandibular condyle.

Evaluation of Hay-Type and Grazing Tolerant Alfalfa Hybrids in Season-Long or Complementary Rotational Stocking Systems for Beef Cows

Pastures containing hay-type and grazing tolerant alfalfa hybrids were grazed in a season-long or complementary rotational stocking system with Nfertilized smooth bromegrass. The pastures were stocked at a seasonal density of .8 cow-calf pairs per acre for 120 days in 1998 and 141 days in 1999. Pastures were intensively managed by daily stripstocking with the assumptions that 50% of live forage was available and daily live dry matter consumption of each cow-calf pair was 3.5% of the cow’s body weight. First-cutting forage was harvested as hay from 40% of the pasture acres to remove excess forage growth early in the grazing season. Grazing occurred on the remaining 60% of each pasture for the first 44 and 54 days and 100% of each pasture after days 45 and 55 in 1998 and 1999, respectively. Proportions of ‘Amerigraze’ and ‘Affinity’ alfalfa in the live forage dry matter decreased by 70% and 55% in pastures stocked season-long and by 60% and 42% in pastures used for complementary stocking (alfalfa type, p<.05; grazing management, p<.05) in 1998, but decreased by a mean of 72% and was unaffected by hybrid or stocking system in 1999. Cows grazing either alfalfa hybrid by either grazing system had greater weight gains during the breeding and overall grazing seasons and greater increases in body condition score pre-breeding and during the breeding season than the cows that grazed smooth bromegrass for the entire season in 1998. Also, cows grazing either alfalfa hybrid in the season-long system had greater breeding season increases in body condition score than cows grazing alfalfa in the complementary system with smooth bromegrass in 1998. Cows grazing in the season-long alfalfa system had greater prebreeding season weight (p<.10) increases and condition score (p<.05) increases than cows grazing alfalfa in the complementary system in 1999. Daily and seasonal body weight gains of calves were not affected (p>.10) by the presence of alfalfa in 1998 or by alfalfa type and grazing management in 1998 and 1999. Total animal production (cow and calf) in 1998 was greater (p<.10) from the season-long alfalfa pastures compared with the complementary stocked pastures. Total (p<.10) and live (p<.05) forage masses, estimated by monthly clippings, were greater in September of 1998 from the season-long alfalfa pastures than pastures using alfalfa for complementary stocking. Total (p<.10) and live (p<.05) forage masses were greater in August of 1999 from season-long alfalfa pastures than pastures using alfalfa for complementary stocking.

Evaluation of Hay-Type and Grazing Tolerant Alfalfa Hybrids in Season-Long or Complementary Rotational Stocking Systems for Beef Cows

Pastures containing hay-type and grazing tolerant alfalfa hybrids were grazed in a season-long or complimentary rotational stocking system with Nfertilized smooth bromegrass. The pastures were stocked at a seasonal density of .8 cow-calf pairs per acre for 120 days. Pastures were intensively managed by daily strip-stocking with the assumptions that 50% of live forage was available and daily live dry matter consumption of each cow-calf pair was 3.5% of the cow’s body weight. First-cutting forage was harvested as hay from 40% of pasture acres to remove excess forage growth early in the grazing season. Forage was grazed from the remaining 60% of each pasture for the first 44 days of the experiment and then from the entire pasture thereafter. Live forage yields, estimated by monthly clippings, were greater in May and September on the season-long alfalfa pastures compared with the complementary pastures and on the alfalfa pastures compared with the N-fertilized smooth bromegrass pastures. The proportions of legumes in the live dry matter in pastures with grazing tolerant and hay-type alfalfas in the season-long grazing systems declined by 70% and 50%, respectively, in the 120 day trial. The proportions of legumes in the live dry matter in pastures with grazing tolerant and the hay-type alfalfas in the complementary grazing system declined 60% and 42%, respectively, in the 120 day trial. Cows grazing either alfalfa hybrid by either management system had greater weight gains during the breeding and grazing seasons and greater increases in body condition score prebreeding and during the breeding season than the cows that grazed N-fertilized smooth bromegrass for the entire season. Also, cows grazing either alfalfa in the season-long system had greater breeding season increases in body condition score than cows grazing alfalfa in the complementary system with N-fertilized smooth bromegrass. Daily gains and seasonal gains of calves from cows grazing the alfalfa pastures tended to be greater than those grazing N-fertilized smooth bromegrass. Within alfalfa treatments, calves of cows grazing alfalfa pastures in the season-long system tended to produce more pounds per acre than those of cows grazing alfalfa in the complementary systems.