In a better world, complementary, alternative and integrative medicine (CAM) would be available to everyone. But in a nation facing spiraling health care costs, CAM therapies might seem like unaffordable luxuries.
That raises the question: Is CAM cost-effective?
A new paper by two Bastyr University alumni gathers promising evidence that it may be. Setareh Tais, ND ('09), and Erica Oberg, ND ('03), MPH, recently published “The Economic Evaluation of Complementary and Alternative Medicine” in Natural Medicine Journal. By reviewing studies on heart disease, diabetes, cancer prevention, back pain, chronic pain and bowel disorders, the authors found potential for significant cost savings through CAM:
Although more prospective outcome studies are needed to evaluate the cost-effectiveness of CAM, there have been published research studies demonstrating that CAM is cost-effective and may present cost-savings due to inexpensive treatments, lower technology interventions, and its emphasis on preventative medicine.
The paper challenges conventional wisdom that doctor time is more expensive than technology-focused medicine. CAM therapies emphasize the patient-healer relationship over pharmaceuticals and surgery. Consider the following examples: A naturopathic doctor (ND) who spends 60 minutes taking your health history and discussing treatment options at a first-time visit; a traditional Chinese medicine practitioner who teaches breathing techniques for stress; or a nutritionist who offers cooking tips for unfamiliar grains and vegetables.
Those initial visits may take longer, but the investment could pay off for patients and health care funders alike.
Major Advantages for Heart Disease and Diabetes
CAM’s focus on prevention could be one of its greatest strengths, according to Dr. Tais and Dr. Oberg. They cite one recent clinical study that found that a year of naturopathic care led to a reduction in 10-year cardiovascular risk of nearly 4 percent. It also reduced the prevalence of metabolic syndrome by 27 percent compared with conventional care.
That translates to a societal cost savings of $1,138 per participant each year and an employer cost savings of $1,187 compared with conventional care, the authors found. “The only cardiovascular disease intervention known to be of lower cost is daily aspirin,” they write.
They found a similarly strong case for diabetes, another leading health issue in the United States. One major study of type 2 diabetes compared adults who received metformin, a common diabetes drug, with others who participated in a lifestyle program focused on weight loss through diet and exercise.
The lifestyle program was nearly twice as effective as the drug in preventing diabetes, reducing disease rates by 58 percent. The lifestyle program would cost $8,800 per quality-adjusted life years (a common health research metric) compared with $29,000 for metformin therapy.
Dr. Tais and Dr. Oberg found other evidence for a range of diseases, including cancer and fibromyalgia. In one study, naturopathic care for back pain (a three-month regimen of acupuncture, relaxation training, exercise, dietary advice and written education on back care) led to savings of $1,212 per participant compared with a standardized physiotherapy program.
The authors clarify that each study they reviewed has limitations and that much more research is needed on the comparative costs of CAM. With a growing body of evidence that CAM is effective, it’s time to show that it’s economic too, says Dr. Oberg, who is the director of clinical services at Bastyr University Clinic in San Diego.
“Understanding both the effectiveness and cost-effectiveness of different models of care is critical,” she says. “Studies of CAM and naturopathic medicine demonstrate both.”
A Public Case for CAM Access
Cost-effectiveness could be an important argument as natural-medicine providers seek increased roles in public health. Dr. Tais and Dr. Oberg wrote their paper to help increase the number of states that license NDs and expand the scope of practice in licensed states to reflect the full scope of primary care that NDs are trained to deliver.
"We've been doing research on the benefits of increasing insurance coverage for naturopathic doctors," says Dr. Tais, a board member at the California Naturopathic Doctors Association. "In doing that, I've realized there is a global benefit to educating the public that naturopathic doctors are primary care providers who provide holistic and cost-effective care."
Dr. Tais, who recently opened a practice in Fresno, California, says economic research will help patients gain broader access to naturopathic medicine under the Affordable Care Act, which could expand insurance coverage for CAM and naturopathic medicine.
“Research on cost-effectiveness tells policy-makers and lobbyists what we can do from a societal perspective with cost savings,” she says. “That’s what we need to ensure naturopathic doctors are fully included in Obamacare."
“Future research needs to be pragmatic,” she says. “That means not only studying costs, but measuring outcomes that matter to patients. A statistically significant difference in a lab value isn’t the only thing that matters to patients. They want to know: ‘What treatments are best for me as an individual? What will help me feel better and spend less time in the doctor’s office?’”