202574 Are complementary and alternative medicines always cost-effective to the patients? Evidence from a rural setting in south India

Monday, November 9, 2009

Subrata Mukherjee, MA, MPhil, PhD , International Health Unit, CRCHUM, University of Montreal, Montreal, QC, Canada
S. Haddad, MD, PhD , Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
Delampady Narayana, PhD , Centre for Development Studies, Thiruvananthapuram, India
Gisèle Contreras, MSc , Department of social and preventive medicine, Université de Montréal, Montreal, QC, Canada
Introduction: Apart from the mainstream Allopathic system, there are six other officially recognised systems of medicine in India. The common perception among many people is alternative and complementary medicines (CAM) are less expensive and more effective in the long-term with less or no side effects compared to Allopathic. This paper (i) intends to identify the characteristics of the patients who go for CAM; and (ii) examines whether CAM are always cost-effective from the perspectives of the patients, when assessed at the end of the episodes/year.

Method: The paper uses longitudinal data on 4743 illness episodes reported by 522 households – surveyed in the Wayanad district in south-India during 2003-04. Components of cost effectiveness are measured using: (a) monetary cost of treatment; (b) duration of the episode; (c) number of OP visits for the same episode; (d) any shift from CAM to Allopathic during the episode; (e) repeat of episodes with similar symptoms.

Results: CAM account for 19% of all first-contacts to a healthcare provider. Utilisation of CAM is significantly associated with sex, age group, severity of illness, number of symptoms, social class and economic status. Though CAM is substantially cheaper than Allopathic, in terms of duration of episode, number of OP visit, likelihood of shifting to Allopathic system and repeat of episodes with similar symptoms, CAM do not show clear advantages, when controlled for the severity and type of healthcare need.

Conclusion: Evidence suggests that CAM are utilised by people (especially the poor) more on ‘less cost' ground and less on ‘more effectiveness' ground.

Learning Objectives:
1. Design indicators which can assess the cost-effectiveness of different systems of medicines from patients' perspectives for common illnesses. 2. Formulate a health information system which can routinely collect, analyse and describe the cost-effectivenes of different systems of medicines based on patients survey and facility level data.

Keywords: Alternative Medicine/Therapies, Cost-Effectiveness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working as a co-researcher in a project titled ‘ Access to Health Care and Basic Minimum Services in Kerala, India (Phase 2) Vulnerability and Health in Wayanad, Kerala, Action Research Initiative’. The project is led by Drs Slim Haddad and D Narayana. The present paper is based on the evidence base generated by this project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.