Met homeopathische 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
Authors
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
Mini Biography
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.
Abstract
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 Linear Models.
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.
Introduction
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.
Objective
We aimed to compare medical outcome of homoeopathic and conventional treatments.
Methods
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 Humboldt University.
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.
Results
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 type

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).
Conclusion
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.
References
(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 A.D.
(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
Summary
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 treatment.
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 treatments on
psychological symptoms.
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.