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Assessing morphological characteristics within traditional Chinese tongue diagnosis—A reliability study
ARTICLE IN PRESS S52 Conclusions: The mistletoe preparation Iscador might have a prolonging effect on the overall survival of cervical, corpus uteri and ovarian cancer patients of all stages. In the short term, psychosomatic self-regulation as a measure of quality of life increases significantly more under complementary Iscador therapy than under conventional therapy alone in all studies measured. 10.1016/j.eujim.2008.08.099
CHRONIC PAIN SYNDROMES Assessing morphological characteristics within traditional Chinese tongue diagnosis—A reliability study Y. Lia, K. Lindea, S. Hagerb, J. Daib, D. Melcharta a
Technische Universita ¨t Mu ¨ nchen, Zentrum fu ¨r naturheilkundliche Forschung, Mu ¨ nchen, Germany b TCM Klinik, Ko ¨tzting, Germany Background: The assessment of the patient’s tongue is a crucial diagnostic tool in traditional Chinese medicine. However, the reliability and validity of tongue diagnosis has rarely been investigated. As a first step in what we hope will develop to a series of studies on tongue diagnosis we investigated the reliability of the assessment of morphological characteristics. Methods: A random sample of digital tongue photographs from 101 patients was taken from a larger database in a hospital for traditional Chinese medicine in Ko ¨tzting, Germany. Three (two Chinese, one German) physicians with extensive experience in tongue diagnosis independently assessed 14 morphological items selected after two small pilot series. Inter-rater reliability was assessed with Cohen’s kappa (classification of agreement: o0.40 poor, 0.40–0.59 moderate, 0.60–0.74 good, and 40.74 excellent). Results: Kappa-values for the 14 items ( three pairs of raters ¼ 42 kappa values) covered a broad range from 0.17 to 0.89. Agreement was classified as poor in 12 comparisons, as moderate in 20, as good in 4 and as excellent in 6 comparisons. Items with good or excellent agreement for all three pairs of raters were teeth prints and colour of tongue coating. Raters often disagreed whether spots were present (kappao0.40). Assessments of colour showed low to moderate agreement and assessments of the type of tongue coating were highly variable. Conclusions: In this study agreement in the assessment of morphological characteristics of the tongue between three experienced raters was highly variable. Assessments were performed under clinical conditions with limited standardized instructions for decisions. Agreement could probably be increased considerably with intense standardization; however, this does not seem to reflect normal clinical conditions. 10.1016/j.eujim.2008.08.100
Poster presentations
Cost-effectiveness of acupuncture in the treatment of selected musculoskeletal system disorders T. Reinhold, C.M. Witt, S.N. Willich Institute for Social Medicine, Epidemiology and Health Economics, Charite´ University Medical Center, Berlin, Germany Background and objectives: Although acupuncture is frequently used in patients suffering from chronic pain disorders, there is a lack of information regarding the economic impact of this therapy in the German health-care system. The primary objective of publications, summarized in this dissertation, was to determine the cost-effectiveness of acupuncture treatment in addition to routine care compared to routine care on its own. As underlying medical conditions, chronic pain due to osteoarthritis, chronic pain of the neck and chronic pain of the lower back were considered. Methods: Three randomized controlled trials were performed. During the 3-month study duration, patients in the acupuncture group received between 10 and 15 acupuncture treatments. The control group was designed as a waiting list control, which also received acupuncture after 3 months. All patients were allowed to receive usual care treatments. The resource use was measured using statutory health insurance data, and the health-related quality of life was assessed using patient questionnaires (SF-36). The primary economic outcome measure was the incremental cost-effectiveness ratio (ICER) of additional acupuncture. For the secondary we performed cost comparison analyses. Further sensitivity analyses were conducted to test the results for robustness. Results: In the investigated conditions, acupuncture treatment was associated with additional costs. The increase in costs was primarily due to the costs of the acupuncture sessions (overall group cost differences after 3 months: osteoarthritis pain 470 EUR [95%CI 136–803 EUR], chronic pain of the neck 277 EUR [95%CI 176–379 EUR] and chronic pain of the lower back 280 EUR [95% CI 148–412 EUR]). A significant increase was observed in patients quality of life in the acupuncture group compared to control group patients (QALY-difference after 3 months: osteoarthritis pain 0.02470.019, chronic pain of the neck 0.02470.004, and chronic pain of the lower back 0.02770.004). As a result, the ICER for additional acupuncture was within a cost-effective range (overall ICER: all diagnoses: 11,945 EUR, osteoarthritis pain 17,845 EUR, chronic pain of the neck 12,469 EUR, chronic pain of the lower back 10,526 EUR). The variation of selected predictive factors (e.g. charge of an acupuncture session, acupuncture effect duration, etc.) confirmed previous findings. Conclusion: As a main result of our study, acupuncture in addition to routine care is a useful add-on therapy, which was associated with additional costs as well as improved quality of life outcomes. Regarding international cost-utility benchmarks of about 50,000 EUR per QALY gained, acupuncture seems to be a cost-effective treatment for all investigated diagnoses. 10.1016/j.eujim.2008.08.101
CHRONIC PAIN SYNDROMES Assessing morphological characteristics within traditional Chinese tongue diagnosis—A reliability study Y. Lia, K. Lindea, S. Hagerb, J. Daib, D. Melcharta a
Technische Universita ¨t Mu ¨ nchen, Zentrum fu ¨r naturheilkundliche Forschung, Mu ¨ nchen, Germany b TCM Klinik, Ko ¨tzting, Germany Background: The assessment of the patient’s tongue is a crucial diagnostic tool in traditional Chinese medicine. However, the reliability and validity of tongue diagnosis has rarely been investigated. As a first step in what we hope will develop to a series of studies on tongue diagnosis we investigated the reliability of the assessment of morphological characteristics. Methods: A random sample of digital tongue photographs from 101 patients was taken from a larger database in a hospital for traditional Chinese medicine in Ko ¨tzting, Germany. Three (two Chinese, one German) physicians with extensive experience in tongue diagnosis independently assessed 14 morphological items selected after two small pilot series. Inter-rater reliability was assessed with Cohen’s kappa (classification of agreement: o0.40 poor, 0.40–0.59 moderate, 0.60–0.74 good, and 40.74 excellent). Results: Kappa-values for the 14 items ( three pairs of raters ¼ 42 kappa values) covered a broad range from 0.17 to 0.89. Agreement was classified as poor in 12 comparisons, as moderate in 20, as good in 4 and as excellent in 6 comparisons. Items with good or excellent agreement for all three pairs of raters were teeth prints and colour of tongue coating. Raters often disagreed whether spots were present (kappao0.40). Assessments of colour showed low to moderate agreement and assessments of the type of tongue coating were highly variable. Conclusions: In this study agreement in the assessment of morphological characteristics of the tongue between three experienced raters was highly variable. Assessments were performed under clinical conditions with limited standardized instructions for decisions. Agreement could probably be increased considerably with intense standardization; however, this does not seem to reflect normal clinical conditions. 10.1016/j.eujim.2008.08.100
Poster presentations
Cost-effectiveness of acupuncture in the treatment of selected musculoskeletal system disorders T. Reinhold, C.M. Witt, S.N. Willich Institute for Social Medicine, Epidemiology and Health Economics, Charite´ University Medical Center, Berlin, Germany Background and objectives: Although acupuncture is frequently used in patients suffering from chronic pain disorders, there is a lack of information regarding the economic impact of this therapy in the German health-care system. The primary objective of publications, summarized in this dissertation, was to determine the cost-effectiveness of acupuncture treatment in addition to routine care compared to routine care on its own. As underlying medical conditions, chronic pain due to osteoarthritis, chronic pain of the neck and chronic pain of the lower back were considered. Methods: Three randomized controlled trials were performed. During the 3-month study duration, patients in the acupuncture group received between 10 and 15 acupuncture treatments. The control group was designed as a waiting list control, which also received acupuncture after 3 months. All patients were allowed to receive usual care treatments. The resource use was measured using statutory health insurance data, and the health-related quality of life was assessed using patient questionnaires (SF-36). The primary economic outcome measure was the incremental cost-effectiveness ratio (ICER) of additional acupuncture. For the secondary we performed cost comparison analyses. Further sensitivity analyses were conducted to test the results for robustness. Results: In the investigated conditions, acupuncture treatment was associated with additional costs. The increase in costs was primarily due to the costs of the acupuncture sessions (overall group cost differences after 3 months: osteoarthritis pain 470 EUR [95%CI 136–803 EUR], chronic pain of the neck 277 EUR [95%CI 176–379 EUR] and chronic pain of the lower back 280 EUR [95% CI 148–412 EUR]). A significant increase was observed in patients quality of life in the acupuncture group compared to control group patients (QALY-difference after 3 months: osteoarthritis pain 0.02470.019, chronic pain of the neck 0.02470.004, and chronic pain of the lower back 0.02770.004). As a result, the ICER for additional acupuncture was within a cost-effective range (overall ICER: all diagnoses: 11,945 EUR, osteoarthritis pain 17,845 EUR, chronic pain of the neck 12,469 EUR, chronic pain of the lower back 10,526 EUR). The variation of selected predictive factors (e.g. charge of an acupuncture session, acupuncture effect duration, etc.) confirmed previous findings. Conclusion: As a main result of our study, acupuncture in addition to routine care is a useful add-on therapy, which was associated with additional costs as well as improved quality of life outcomes. Regarding international cost-utility benchmarks of about 50,000 EUR per QALY gained, acupuncture seems to be a cost-effective treatment for all investigated diagnoses. 10.1016/j.eujim.2008.08.101