Dividing by Zero. Is Homeopathy Cost/Effective?

Dividing by Zero. Is Homeopathy Cost/Effective?

In medicine they do a lot of cost-effective analysis of therapies. Is a therapy worth the cost and the complications for the benefits received? They bandy about concepts like 'number needed to treat' and 'quality of life' and 'disability-adjusted life year' and other metrics to determine if an intervention is of benefit to patients and society.

Is the bang worth the buck? I have to admit I do not pay a great deal of attention to these issues; as an infectious disease clinician the issues are rarely applicable to day to day practice and I leave it to wiser heads than mine whether hepatitis C screening or use of statins are worth it, however 'worth it' may be defined.

Implicit in these analyses is that the therapy has effects, both beneficial and detrimental.

How much bang for the buck could you get from an inert therapy like homeopathy? After all, if you calculate cost/effective and the value of effective is zero, the answer has no meaning, exactly like the basis of homeopathy.

There have been studies to try and determine if homeopathy adds clinical and economic benefit to patients, and a meta-analysis had mixed results

Although the identified evidence of the costs and potential benefits of homeopathy seemed promising, studies were highly heterogeneous and had several methodological weaknesses. It is therefore not possible to draw firm conclusions based on existing economic evaluations of homeopathy.

A new study this month, Can Additional Homeopathic Treatment Save Costs? A Retrospective Cost-Analysis Based on 44500 Insured Persons, looks at the issue of the effects of dividing by zero aka homeopathy.

44,500. That is a lot of patients. They matched homeopathy users to non-homeopathy users for a large number of diseases.

Not only was homeopathy use associated with more cost, it also suggests that homeopathic users did worse: more sick days, more hospital days, and homeopathy users had more diagnoses over the 18 months studies.

Homeopathy patients did worse and cost more.

The authors suggest

In general, homeopathic treatment follows a more holistic approach that considers the whole person and his or her resources. This approach could result in diagnosing and treating other somatic or mental disorders as well and in more frequently providing patients with sick leave notes allowing them to rest. This more holistic approach could lead to the initiation of further conventional care, which is associated with additional costs. This possible situation might explain why the homeopathic group had more diagnoses after 18 months, with a peak at the beginning of the integrated care contract, although the numbers of diagnoses were comparable between the groups at baseline. In months 1–3, considering all diagnosis groups, homeopathic patients had 126.2% more diagnoses than the controls did.

I would suspect that they cost more and did worse because they were being mismanaged by providers who believe in magic water. You can not expect competent care from those who practice fantasy. And the more diagnoses? The author suggest

The difference in the observed number of diagnoses after the beginning of the integrated care contract might be explained by some patients who visited the homeopathic physician for the first time and the associated extensive initial consultation including broader diagnostics.

I would suspect it is more due to the propensity pseudo-medical providers to both make up nonexistent diagnoses and misdiagnose real diseases. Practitioners of pseudo-medicine are good at needlessly multiplying diagnoses and adding useless therapies;  it is what they do best. Occam is not a razor they shave with.

I wonder. Has anyone ever been to an alternative provider who told them "You are fine. Nothing I can do for you" or "I do not know what is wrong with you, but I can't help." I bet not.

Seeing incompetent purveyors of magic results in worse outcomes at more cost. What a shock..

So at least with homeopathy, there is a result from dividing by zero. 

Points of Interest 08/06/2015
Points of Interest 08/03/2015

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