Homeopathy in healthcare -- Effectiveness, appropriateness, safety, costs : an HTA report on homeopathy as part of the Swiss Complementary Medicine Evaluation Programme

Annotation This volume includes the full Health Technology Assessment (HTA) report on effectiveness, appropriateness, safety and costs of homoeopathy in health care. The report was commissioned by the Swiss health authorities to inform decision-making on the further inclusion of homoeopathy in the list of services covered by statutory health insurance. Other studies carried out as part of the Swiss Complementary Medicine Evaluation Programme (PEK) caused a massive stir due to their schematic and exclusively quantitative (negative- )outcomes for homoeopathy. The present report, in contrast, offers a differentiated evaluation of the practice of homoeopathy in health care. It confirms homoeopathy as a valuable addition to the conventional medical landscape a status it has been holding for a long time in practical health care Cover 1 Homeopathy in Healthcare – Effectiveness, Appropriateness, Safety, Costs 4 ISBN-13 9783642206375 5 Table of Contents 6 1 Introduction 10 2 Backgroundand objectives of HTA 14 2.1 Background 15 2.2 Objectives 16 3 Introduction to the speciality of homeopathy –principles and definition 18 3.1 Preface 19 3.2 The principle of similarity or ‘Law of Similars’ 19 3.3 Homeopathic pharmacology 19 3.4 The homeopathic examination and remedy selection 20 3.5 Medicines: their manufacture, application and mode of action 20 3.6 The concept of disease in homeopathyand conventional medicine 21 3.7 Indications and limitations of homeopathy 22 3.8 Other therapies known as homeopathy 22 3.9 Homeopathy research 23 3.10 References 23 4 Homeopathy: Research and Research Problems (preclinical and clinical) 24 4.1 Introduction and Research Problems 25 4.2 Preclinical Research 26 4.2.1 Fundamental physico-chemical research 26 4.2.2 Botanical studies 27 4.2.3 Animal studies 27 4.2.4 In vitro studies with human cells 28 4.2.5 Conclusion: fundamental preclinical research 28 4.3 Clinical trials 28 4.3.1 Classification 28 4.3.2 An outline of clinical trials 29 4.3.3 Future research 30 4.3.4 Summary clinical studies 31 4.4 References 31 5 General problems withclinical trials in research 36 5.1 The Problems with Randomized Clinical Trials 37 5.2 The Risk of Bias in Clinical Trials 40 5.3 Problems with the Formal Evaluation of Clinical Trialsin Meta-analyses 48 5.4 References 53 6 HTA Homeopathy: Methods and Material 56 6.1 Project Implementation 57 6.2 Methods: Systematic Literature Search 58 6.2.1 Selection of data sources 58 6.2.2 Data sources used 58 6.2.3 Systematic literature search: general search strategyand article selection 63 6.2.4 Systematic literature search for individual HTA aspects:search strategy and article selection 64 6.3 Data Extraction and Evaluation 65 6.3.1 Extraction and evaluation of data / procedure 65 6.3.2 Extraction and evaluation of data 66 6.3.3 Evaluation categories 67 6.4 Data Synthesis 68 6.5 Publications 69 6.5.1 Database research ‘Homeopathy’ 69 6.5.2 Special search: URTI (Upper Respiratory Tract Infection) 71 6.5.3 Safety 72 6.5.4 Cost-effectiveness 72 6.6 References 75 7 International Utilisationof Complementary Medical Approaches 76 7.1 Introduction and Research Questions 77 7.2 Methodology 77 7.3 Results 78 7.3.2 Study design 78 7.3.3 CAM definitions 85 7.3.4 Profile of CAM users 88 7.3.5 Frequency of CAM use 88 7.3.6 Estimation of satisfaction with CAM and CAM effectiveness 92 7.3.7 Reasons for using CAM 94 7.3.8 Use of CAM compared with conventional medicine 95 7.4 Discussion 95 7.5 Conclusion 96 7.6 References 97 8 CAM Conditions and Use in Switzerland 100 8.1 Conditions 101 8.2 The Use of Complementary Medicine in Switzerland:Prevalence, Effectiveness, Acceptanceand the Views of Patients and Physicians 103 8.2.1 Introduction 103 8.2.2 Methodology 103 8.2.3 Results 104 8.2.4 Discussion 106 8.2.5 Conclusion 106 8.2.6 List of study numbers (referred to in the diagrams) 107 9 Overview of Systematic Reviews on the Clinical Efficacy of Homeopathy 110 9.1 Introduction: Systematic Reviews 111 9.2 Literature Search 111 9.3 Presentation of the Studies 112 9.3.1 Reviews on general effectiveness 112 9.3.2 Reviews on special indications: 115 9.3.3 Reviews on special interventions 116 9.3.3 Reviews on special indications with special intervention 117 9.4 Evaluation of the Studies 118 9.4.1 Research question 118 9.4.2 Selection of studies 120 9.4.3 Selection and evaluation of data/information 122 9.4.4 Data synthesis 123 9.5 Discussion and Conclusion 126 9.6 List of Excluded Studies with Reasons for Exclusion 127 9.7 References 133 10 Clinical Studies on the Effectiveness of Homeopathy for URTI/A (Upper Respiratory Tract Infections and Allergic Reactions) 136 10.1 Selection of Indication 137 10.2 Outcome of Literature Search 137 10.3 Summary of Studies: Data Extraction, Internaland External Validity, Results 149 10.3.1 Population, study design and implementation 149 10.3.2 Intervention and control therapy 150 10.3.3 Outcome 151 10.3.4 Results 151 10.3.5 Side effects, initial aggravation, adverse effects 152 10.4 Discussion 152 11 Safety of Homeopathic Use 168 11.1 Introduction 169 11.2 Responses to Treatment 169 11.3 Interaction of Substances 170 11.4 Safety of Application 170 11.5 Scientific Research 170 11.6 Safety: Summary and Conclusion 171 11.7 References 171 12 Cost-effectiveness of Homeopathy 172 12.1 Introduction 173 12.2 Methods of Health Economics 175 12.3 Use of CAM 176 12.4 Costs 177 12.5 Cost-effectiveness 177 12.6 Reimbursement 178 12.7 Data and Studies for Homeopathy 178 12.8 Data and Projects from Switzerland 180 12.8.1 NFP 34 180 12.8.2 Further data from Switzerland 181 12.9 International CAM Studies and Surveys: Patients 182 12.10 International CAM Studies and Surveys on: Physicians/Providers 183 12.11 Pilot Projects in Germany 183 12.12 Discussion 186 12.12.1 Methodology 186 12.12.2 Cost-effectiveness of complementary medical methods 186 12.12.3 Homeopathy 197 12.13 References 198 13 Full discussionof the HTA results 202 13.1 References 212 14 Synopsis 214 14.1 Effectiveness 215 14.2 Reviews 215 14.3 Studies on the Indication Upper Respiratory Tract Infection/Allergy (URTI/A) 216 14.4 Appropriateness 217 14.4.1 Estimation of Demand/Use 217 14.4.2 Safety 217 14.5 Economy 217 3642206379,9783642206375 Springer 2011 Cover......Page 1 Homeopathy in Healthcare – Effectiveness, Appropriateness, Safety, Costs......Page 4 ISBN-13 9783642206375......Page 5 Table of Contents......Page 6 1 Introduction ......Page 10 2 Backgroundand objectives of HTA ......Page 14 2.1 Background......Page 15 2.2 Objectives......Page 16 3 Introduction to the speciality of homeopathy –principles and definition......Page 18 3.3 Homeopathic pharmacology......Page 19 3.5 Medicines: their manufacture, application and mode of action......Page 20 3.6 The concept of disease in homeopathyand conventional medicine......Page 21 3.8 Other therapies known as homeopathy......Page 22 3.10 References......Page 23 4 Homeopathy: Research and Research Problems (preclinical and clinical)......Page 24 4.1 Introduction and Research Problems......Page 25 4.2.1 Fundamental physico-chemical research......Page 26 4.2.3 Animal studies......Page 27 4.3.1 Classification......Page 28 4.3.2 An outline of clinical trials......Page 29 4.3.3 Future research......Page 30 4.4 References......Page 31 5 General problems withclinical trials in research ......Page 36 5.1 The Problems with Randomized Clinical Trials......Page 37 5.2 The Risk of Bias in Clinical Trials......Page 40 5.3 Problems with the Formal Evaluation of Clinical Trialsin Meta-analyses......Page 48 5.4 References......Page 53 6 HTA Homeopathy: Methods and Material......Page 56 6.1 Project Implementation......Page 57 6.2.2 Data sources used......Page 58 6.2.3 Systematic literature search: general search strategyand article selection......Page 63 6.2.4 Systematic literature search for individual HTA aspects:search strategy and article selection......Page 64 6.3.1 Extraction and evaluation of data / procedure......Page 65 6.3.2 Extraction and evaluation of data......Page 66 6.3.3 Evaluation categories......Page 67 6.4 Data Synthesis......Page 68 6.5.1 Database research ‘Homeopathy’......Page 69 6.5.2 Special search: URTI (Upper Respiratory Tract Infection)......Page 71 6.5.4 Cost-effectiveness......Page 72 6.6 References......Page 75 7 International Utilisationof Complementary Medical Approaches......Page 76 7.2 Methodology......Page 77 7.3.2 Study design......Page 78 7.3.3 CAM definitions......Page 85 7.3.5 Frequency of CAM use......Page 88 7.3.6 Estimation of satisfaction with CAM and CAM effectiveness......Page 92 7.3.7 Reasons for using CAM......Page 94 7.4 Discussion......Page 95 7.5 Conclusion......Page 96 7.6 References......Page 97 8 CAM Conditions and Use in Switzerland......Page 100 8.1 Conditions......Page 101 8.2.2 Methodology......Page 103 8.2.3 Results......Page 104 8.2.5 Conclusion......Page 106 8.2.6 List of study numbers (referred to in the diagrams)......Page 107 9 Overview of Systematic Reviews on the Clinical Efficacy of Homeopathy......Page 110 9.2 Literature Search......Page 111 9.3.1 Reviews on general effectiveness......Page 112 9.3.2 Reviews on special indications:......Page 115 9.3.3 Reviews on special interventions......Page 116 9.3.3 Reviews on special indications with special intervention......Page 117 9.4.1 Research question......Page 118 9.4.2 Selection of studies......Page 120 9.4.3 Selection and evaluation of data/information......Page 122 9.4.4 Data synthesis......Page 123 9.5 Discussion and Conclusion......Page 126 9.6 List of Excluded Studies with Reasons for Exclusion......Page 127 9.7 References......Page 133 10 Clinical Studies on the Effectiveness of Homeopathy for URTI/A (Upper Respiratory Tract Infections and Allergic Reactions)......Page 136 10.2 Outcome of Literature Search......Page 137 10.3.1 Population, study design and implementation......Page 149 10.3.2 Intervention and control therapy......Page 150 10.3.4 Results......Page 151 10.4 Discussion......Page 152 11 Safety of Homeopathic Use ......Page 168 11.2 Responses to Treatment......Page 169 11.5 Scientific Research......Page 170 11.7 References......Page 171 12 Cost-effectiveness of Homeopathy......Page 172 12.1 Introduction......Page 173 12.2 Methods of Health Economics......Page 175 12.3 Use of CAM......Page 176 12.5 Cost-effectiveness......Page 177 12.7 Data and Studies for Homeopathy......Page 178 12.8.1 NFP 34......Page 180 12.8.2 Further data from Switzerland......Page 181 12.9 International CAM Studies and Surveys: Patients......Page 182 12.11 Pilot Projects in Germany......Page 183 12.12.2 Cost-effectiveness of complementary medical methods......Page 186 12.12.3 Homeopathy......Page 197 12.13 References......Page 198 13 Full discussionof the HTA results ......Page 202 13.1 References......Page 212 14 Synopsis ......Page 214 14.2 Reviews......Page 215 14.3 Studies on the Indication Upper Respiratory Tract Infection/Allergy (URTI/A)......Page 216 14.5 Economy......Page 217 This volume includes the full Health Technology Assessment (HTA) report on effectiveness, appropriateness, safety and costs of homoeopathy in health care. The report was commissioned by the Swiss health authorities to inform decision-making on the further inclusion of homoeopathy in the list of services covered by statutory health insurance. Other studies carried out as part of the Swiss Complementary Medicine Evaluation Programme (PEK) caused a massive stir due to their schematic and exclusively quantitative (negative-)outcomes for homoeopathy. The present report, in contrast, offers a differentiated evaluation of the practice of homoeopathy in health care. It confirms homoeopathy as a valuable addition to the conventional medical landscape a status it has been holding for a long time in practical health care. " Gudrun Bornhöft, Peter F. Matthiessen (eds.) ; Translated From The German By Margot M. Saar. Includes Bibliographical References.