behandeling kunnen betere resultaten verkregen worden, dan met conventionele
behandelingen, terwijl de kosten vergelijkbaar zijn. Dit blijkt uit drie
onderzoeken die gepresenteerd worden op de conferentie "Bridging
the Credibility Gap" op 3 en 4 april, georganiseerd door het Royal
London Homeopathic Hospital, voorloper in Europa op het gebied van wetenschappelijk
onderzoek naar homeopathie.
De drie studies zijn verricht door verschillende Europese onderzoeksteams.
1. Het eerste onderzoek is van Gilles Chaufferin, gezondheidseconoom en
werkzaam bij de firma Boiron (Farmaceutische industrie, gespecialiseerd
in homeopathische geneesmiddelen, Lyon). Hij vergeleek de resultaten die
verkregen worden bij homeopathische en niet-homeopathische huisartsen
bij 500 jonge kinderen met steeds terugkerende verkoudheden. Hij concludeerde
dat met homeopathische behandeling betere resultaten werden geboekt, afgaand
op medische effectiviteit, kwaliteit van leven en de verzuimdagen die
de ouders moesten opnemen om voor hun zieke kind te zorgen. De kosten
van beide behandelmethoden waren gelijk.
2. Het tweede onderzoek is van Claudia Becker-Witt, onderzoeker en hoofd
van de afdeling Complementaire Geneeskunde bij het Instituut voor Sociale
Geneeskunde, Epidemiologie en Gezondheidseconomie bij de Charité
Universiteit te Berlijn. Zij vergeleek eveneens de resultaten verkregen
bij conventionele en homeopathisch werkende huisartsen bij 500 volwassenen
en kinderen met een veelheid aan chronische aandoeningen (volwassenen:
lage rugpijn, hoofdpijn, slapeloosheid, depressie, chronische bijholteontsteking;
kinderen: hooikoorts, astma, atopisch eczeem) en kwam tot een vergelijkbare
conclusie: homeopathie leverde betere resultaten op, vooral bij kinderen,
terwijl de kosten hetzelfde waren.
3. Het derde onderzoek werd verricht door Corina Güthlin, psycholoog
en sinds 1995 bezig met evaluatie van complementaire geneeskunde (Universiteit
Freiburg). Zij bestudeerde patiënten wier zorgverzekeraar de mogelijkheid
van acupunctuur en homeopathie aanbood. Zij onderzocht alle 750 patiënten
die een homeopathische behandeling kozen en concludeerde dat homeopathische
behandeling positieve resultaten opleverde, met name verbetering van de
kwaliteit van leven. De kosten werden hier niet onderzocht.
4. Effectiveness and Costs of Homeopathy Compared to Conventional Medicine
– a Prospective Multicenter Cohort Study
C Becker-Witt, T Keil, S Roll, D Menke, W Vance, K Wegscheider, SN Willich
Institute for Social Medicine, Epidemiology, and Health Economics, Hospital
Charité, Humboldt University of Berlin, Germany
Dr. Claudia Becker-Witt studied medicine at Freie Universität in
Berlin and Ruhr Universität in Bochum. Since 1992 her professional
focus has been on the therapeutic and scientific aspects of homeopathy.
In addition, she has had special training in epidemiology and statistics.
In 1999 she completed her doctoral studies and, in the year 2000, received
the Karl and Veronica Carstens Foundation research prize for her doctoral
thesis on "Physical research in homeopathy". Since 1997 she
has been head of the Complementary Medicine Working Group at the Institute
of Social Medicine, Epidemiology, and Health Economics, which is part
of the Charité University Medical Center in Berlin, Germany. In
this capacity, she is responsible for both research and teaching policies
in Complementary Medicine. Of chief interest in her own research are clinical
and epidemiological studies of homeopathy and acupuncture.
Objective: To evaluate the effectiveness and costs of homeopathic treatment
compared to conventional treatment in primary care.
Material and methods: In a prospective cohort study, patients with chronic
diseases (adults: low back pain, headache, insomnia, major depression,
chronic sinusitis; children: allergic rhinitis, asthma, atopic eczema)
were recruited from homeopathic and conventional practitioners. Patients
were monitored at baseline, 6 and 12 months using standardised questionnaires.
The severity of complaints was assessed independently by patients and
physicians on visual rating scales (0-10). Cost data were provided by
the health insurance companies. Analyses were conducted using General
Results: A total of 493 patients were included in the study: 315 adults
(22% men, 78% women, mean age 45(13 years) and 178 children [60% boys,
40% girls, mean age 6.8 ± 4 years]). Children treated with homeopathic
medicine improved significantly compared to those treated conventionally,
both according to patient self-assessment (Homeopathy/Conventional0/12
months H:5.0/2.6; C:4.4./3.2; p<0.01) and physician assessment (H:4.5/2.0;
C:3.9/2.7; p<0.01). Adults in the homeopathic treatment group also
improved significantly compared to those in the conventional treatment
group according to self-assessment (H:5.6/3.2; C:5.9/4.4; p<0.01),
whereas physician assessment yielded no difference (H:5.8/2.6; C:6.2/3.4;
p=ns). No significant differences in costs were observed.
Conclusions: In terms of effectiveness, homeopathic treatment was equal
and, to some extent, superior to conventional treatment. The costs of
both forms of therapy were similar.
Homeopathy is one of the most frequently used and controversial systems
of complementary and alternative medicine . In Germany, 4,500 physicians
have an additional qualification in "classical" homeopathy accredited
by the Homeopathic Medical Association . For Germany there is no systematic
data concerning the effectiveness and costs of homeopathy compared to
conventional treatment. The results of effectiveness studies are of special
interest to insurers because of their economic implications . The present
study was not intended to provide efficacy data, but rather to compare
the effectiveness and costs of the two treatment strategies.
We aimed to compare medical outcome of homoeopathic and conventional treatments.
In this prospective cohort study, patients with chronic diseases (adults:
low back pain, headache, insomnia, major depression, chronic sinusitis;
children: allergic rhinitis, asthma, atopic eczema) were recruited from
homeopathic and conventional practitioners. For each diagnosis type, detailed
inclusion criteria were defined. Patients answered standardised questionnaires
concerning their medical complaints and all previous and current treatments
at baseline, 6 and 12 months. The severity of complaints was assessed
on visual rating scales (0-10, ) independently by patients and physicians.
Patients were only included after giving written informed consent, and
the study was compliant with Good Epidemiological Practice (GEP) and relevant
data-protection laws, and was approved by the Ethics Committee of the
Cost data were provided by the health insurance companies. The primary
endpoint for costs was total direct costs (including hospital stay, outpatient
treatment, medication, and sick pay). Costs were summarized for the 12
months during the study. For statistical evaluation, we pooled the diagnoses
and analysed only completed cases. To examine possible selection bias
resulting from patients lost to follow-up, logistic regression models
were conducted. To model the course over time, we fitted general linear
repeated measurement models to the data and adjusted for age, gender,
education, and duration of symptoms.
A total of 493 patients (Table 1) were included in the study: 315 adults
(22% men, 78% women, mean age 45(13 years) and 178 children (60% boys,
40% girls, mean age 6.8 ± 4 years). For further socio-demographic
data, see Table 2.
Table 1. Distribution of patients by age group, diagnosis and treatment
Table 2. Socio-demographic data and use of medical resources
Complete data were available for 80% of the homoeopathically treated and
66% of the conventionally treated patients, but this was not diagnosis-related.
Children treated with homeopathic medicine improved significantly compared
to those treated conventionally, both according to patient self-assessment
(Homeopathy/Conventional0/12 months H:5.0/2.6; C:4.4./3.2; p<0.01)
and physician assessment (H:4.5/2.0; C:3.9/2.7; p<0.01). Adults in
the homeopathic treatment group also improved significantly compared to
those in the conventional treatment group according to self-assessment
(H:5.6/3.2; C:5.9/4.4; p<0.01), whereas physician assessment yielded
no difference (H:5.8/2.6; C:6.2/3.4; p=ns). No significant differences
in costs were observed (data not shown).
In terms of effectiveness, homeopathic treatment was equal and, to some
extent, superior to conventional treatment. The costs of both forms of
therapy were similar.
(1) Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M
et al. Trends in Alternative Medicine Use in the United States, 1990-1997:
Results of a Follow-Up National Survey. JAMA 1998; 280(18):1569-1575.
(2) Marstedt G, Moebus S. Gesundheitsberichtserstattung des Bundes - Inanspruchnahme
alternativer Methoden in der Medizin. Berlin: Robert Koch Institut, 2
(3) Sommer JH, Burgi M, Theiss R. [Complementary medicine in health insurance.
Economic analysis of the effects of including complementary procedures
in health insurance. Project within the scope of the "Complementary
Medicine" Research Program 34]Komplementärmedizin in der Krankenversicherung.
Gesundheitsökonomische Analyse der Wirkungen des Einbezuges komplementärmedizinischer
Leistungen in die Krankenversicherung. Projekt im Rahmen des Nationalen
Forschungsprogrammes 34 "Komplementärmedizin". Schweiz
Med Wochenschr Suppl 1998; 102:1S-129S.
(4) Huskisson EC, Scott J. VAS Visuelle Analog-Skalen; auch VAPS Visual
Analogue Pain Scales, NRS Numerische Rating-Skalen; Mod. Kategorialskalen;
Mod. In: Westhoff G, editor. Handbuch psychosozialer Meßinstrumente.
Ein Kompendium für epidemiologische und klinische Forschung zu chronischer
Krankheit. 1993: 881-885.
4. Unio Homoeopathica Belgica SURVEY 2001
This is an observational study of 782 unselected patients receiving homeopathic
treatment in Belgium from 80 general practitioners.
The patients suffered from a wide range of conditions affecting most organ
systems. More than three quarters (78%) of those who gave ratings of their
physical state prior to homeopathic treatment complained of symptoms of
sufficient severity to interfere with their daily life; 15% were unable
to pursue their occupation or education. Similar proportions also complained
of psychological symptoms.
A separate study (see Appendix II) showed that there were no significant
differences between the homeopathic and conventional GPs in their use
of medical imaging or laboratory tests, suggesting that the patient groups
being treated were not too dissimilar.
Following homeopathic treatment there were significant reductions in consultations
with other specialists and generalists, and in the cost of treatment.
The largest cost savings were made by patients with the worst ratings
of their physical condition prior to seeking homeopathic treatment.
Homeopathic consultations were significantly longer than their previous
general medical consultations had been (37 minutes vs. 15 minutes). Short
consultation times were a factor affecting dissatisfaction with previous
While 333 different remedies were prescribed, just 21 of these accounted
for half of all prescriptions.
More than half (59%) were prescribed only once. A third (34%) of patients
received more than one remedy. A majority of doctors (68%) based their
prescribing on the totality of the patients' symptoms.
There were significant differences between remedies in the outcomes reported
by patients for both physical and psychological symptoms, although the
meaning of this finding is not clear.
The physicians were able to discontinue one or more conventional drug
treatments in over half (52%) of the patients. The top three were CNS
(including psychotropic) drugs (21%), drugs for respiratory conditions
(16%) and antibiotics (16%).
The cost of conventional drugs prescribed by 47 of the homeopathic GPs
was compared with the national picture for Belgium. On average, the homeopaths
prescribed only one third the number of conventional drugs compared to
their conventional general practitioner colleagues. This figure was lowest
for antibiotics, which were prescribed only one fifth as often. If all
GPs in Belgium showed the same prescribing profile as the homeopaths,
the national drug bill would theoretically be reduced by about two thirds,
or about €775,000,000.
Conventional drugs were prescribed to about a quarter of patients (27%),
the bulk of these being antibiotics and cardiovascular medication. The
antibiotics were almost exclusively (95%) used to treat respiratory infections.
Patients' satisfaction ratings with their homeopathic treatment were extremely
high (95% fairly or very satisfied), while their ratings of their previous
treatment was much lower (20%). It is possible that many had sought homeopathic
treatment because of their dissatisfaction with conventional treatment.
The great majority (89%) said that homeopathy had improved their physical
condition; 8.5% said that it had made no difference and only 2.4% that
homeopathy had worsened their condition. This contrasts with their previous
conventional treatment, which had improved 13% of patients, made no difference
to 32%, and had worsened the condition of over half (55%).
A similar picture was seen in ratings of the efficacy of prior and homeopathic
Future studies can be improved by a better questionnaire design which
allows clearer discrimination of time frames. Questions about previous
treatments were answered by patients who had used homeopathy for over
ten years, and the reliability of such estimates is doubtful. Nevertheless,
the extremely large magnitude of differences observed between ratings
of previous and homeopathic treatments makes it very unlikely that these
differences are artefacts.