5.  CAN COMPLEMENTARY MEDICINE
     BE COST EFFECTIVE?


5.1  The cost of complementary medicine

During the period of the research, the cost of providing the complementary medicine service was around £17,000 per annum, a cost which includes complementary practitioner time, administrative time and additional costs such as herbal medicines or acupuncture needles. This price does not include practice overheads (room rent, heating, lighting etc.).

For an illustration of the costs of complementary medicine, it is useful to look at the 41 patients in this subsample from section 4. These received, between them, 48 sets of referrals to the complementary health service for their health problem (seven had a second set of sessions during the year following the completion of their initial referral). The cost of treating these 41 patients with complementary medicine would therefore have been around £2,600. (Table 32).

Table 32  Cost of complementary therapies for sample patients

Item	Number of referrals	Total costs for group
Sessions with practitioners including admin. time (£48 per referral)	48	£2,302
Herbal medicines (£30 per herbal referral)	6	£180
Acupuncture needles (£4.50 per acupuncture referral)	19	£85.50
Total		£2,567.50

5.2  Estimating the savings derived from availability of complementary medicine

It is far from easy to put a price on the savings made from the reduction in the use of other health services established in section 4. Given the range of health conditions of patients referred to the service, the costs of health care provision varied considerably. We had, therefor to rely on average costs, assuming, for example, an average number of sessions for physiotherapy, complementary medicine etc., or an X-ray of average cost. The costs of medication were the easiest to calculate, using Mims, although sometimes assumptions had to be made about which particular version of a medicine had been supplied. For costs GP time, physiotherapy, X-rays, blood tests, or referral to consultants, we consulted the Somerset Health Authority, also comparing these to the unit costs for community care calculated by PSSRU (Netton 1994). In most cases, the figures from both sources are very similar.

5.2.1  Cost savings by a patient subsample

Using estimates based on this data, it was possible to establish that the subsample of 41 patients examined in section 4 had cost just over £4,000 in NHS treatments, in the year prior to referral, for the condition for which they were referred. After treatment, these costs went down to just over £1,500, giving a saving of around £2,500 (Table 33).

Table 33  Total costs before and after complementary medicine treatment

	In year before treatment		In year after treatment
	Number of sessions/referrals	Total costs	Number of sessions/referrals	Total costs	Difference
Medication	88 prescriptions	£691.69	48 prescriptions	£309.22	£382.47
GP sessions (£7.50* each)	128 sessions	£975.36	88 sessions	£670.56	£304.80
Physiotherapy (£63* per referral)	7 referrals	£441	2 referrals	£126	£315
Counselling (£520* per referral)	2 referrals	£1040	0	0	£1040
X-ray (£17.50* each)	8	£140	4	£70	£70
Blood/urine tests (£7.50* each)	4	£30	3	£22.5	£7.50
Consultant referrals (£195* per referral)	7 referrals	£1365	5 referrals	£975	£390
Total		£3773.05		£1523.28	£2509.77

* Costs are based on average Somerset Health Authority costs

For consultant referrals we have assumed an average of three consultations per referral, but have excluded the cost of any hospital treatment that may have resulted from this. GP visits are based on an average 9 minute consultation

However, these costs were very unevenly spread. Referrals to the mental health team for counselling, and referrals to consultants were the major expenditures. Sessions with the GP also made up a significant part of the expenditure, followed by the cost of medication. On the whole, the medications that the majority of patients (ie. those with musculo-skeletal problems) were taking were not expensive, but a small number of patients (6) accounted for over £600 of this bill. Reduction in costs were largest for this group of patients (Table 34).

Table 34  Costs of medication for problem treated

	In year prior to treatment		In year after treatment
Cost of prescriptions	Number of patients	Total cost of prescriptions	Number of patients	Total cost of prescriptions
0	18		26
£1-5	10	£21.56	7	£16.66
£6-10	6	£45.35	3	£24.97
Over £10	7	£624.78	5	£267.59
Total	41	£691.69	41	£309.22

The savings made by this group of patients in the year following complementary medicine (ie. around £2,500) more or less covered the cost of the complementary medicine provided (ie. £2,570). While it would be dangerous to extrapolate too far on the basis of small numbers, if we assume that this group is more or less representative of the 50% of all the patients treated by the service who have had their problem for over a year, the amount saved per annum would be around £7,500, or around 44% of the annual cost of providing the service. This does, of course, assume that the costs for this group of patients would not have either decreased, or increased, had complementary medicine not been available, a calculation outside the capacity of the present study.

5.2.2  Cost savings in secondary referrals

This result, suggesting that the cost of complementary health service is nearly covered by the savings made elsewhere in the health services is also supported by the analysis of referrals to secondary care. In section 4 we calculated the hypothesised difference between referrals from Glastonbury, and those from other, similar general practices in the county, adjusting this for the increase in size of practice, and general increases in rate of referral across the county. These were only figures for referrals related to musculo-skeletal problems, which made up the majority of referrals to the complementary health service.

When costs were attributed to these estimates, the overall savings in secondary referrals in the year 1995/96 was over £18,000 (Table 35).

Table 35  Comparison between referral costs from Glastonbury and other practices in Somerset

Type of Referral	Difference between actual and hypothesised referrals in 1995/96*	Hypothesised cost savings
Orthopaedic consultations (£195)**	70.9	£13,825.5
Rheumatology consultations (£195)	-7.4	-£1443
Physiotherapy (£63)	91.7	£5,777.1
Totals	155.2	£18,159.1

*   These figures are adjusted for the increased size of the pract ice between 1991/2 and 1995/6
** This price is only for consultations, and not the cost of surgery, hospital bed, physiotherapy etc.

If the complementary health service has made a considerable contribution to the reduction in referrals to secondary care of this kind, this is further evidence that the service is more than covering its costs from savings elsewhere in health service provision. Unfortunately, however, there are no means, within the present system, for funding of this kind to be transferred from secondary care, where the savings have been accrued, to primary care, where the complementary medicine has been provided.

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