Three criteria determine drug reimbursement decisions: therapeutic value, cost effectiveness, and burden of disease. Now, an article from Erasmus University in The Netherlands questions whether it’s sufficient for a drug to meet these criteria, and proposes a 4th hurdle.

Consider how CAM would hold up under such scrutiny based on what we know today.

Lead author, Dr. Joshua Cohen asserts, “Although drugs that are cost effective may lead to unambiguous health gains among patient groups,… the opportunity costs could conceivably lead to a reduction in aggregate health gains, or failure to meet different kinds of equity considerations.”

Dr. Cohen goes further. “It may be a matter of redeployment of resources across healthcare sectors, canceling the funding of (older) pharmaceuticals that are less cost effective, or delisting drugs that are cost effective but target less burdensome conditions.”

In other words, someday it might become policy to not fund an effective treatment for insomnia in order to “better spend” the money on more expensive drugs to treat cancer, for example.

The bottom line for CAM?
As I state on the left sidebar, I view all CAM as making it’s way through the pipeline into mainstream medicine. If Dr. Cohen’s proposition takes hold, most of CAM would never satisfy the 4th criteria and make the transition to mainstream or integrative medicine.

Then again, the fact that Americans spend $34 billion dollars on CAM each year is testament that, for many people, CAM therapies provide benefits that outweigh their costs. Reimbursement is not an issue for them.

Last year, researchers from the University of Arizona in Tucson searched for evidence of CAM cost effective treatment compared to usual care — the first step in becoming eligible to be considered for the fourth criteria. Here’s what they found.

  • Acupuncture for migraine
  • Manual therapy for neck pain
  • Spa therapy for Parkinson’s
  • Self-administered stress management for cancer patients undergoing chemotherapy
  • Pre- and post-operative oral nutritional supplementation for lower gastrointestinal tract surgery
  • Biofeedback for patients with “functional” disorders (eg, irritable bowel syndrome)
  • Guided imagery, relaxation therapy, and potassium-rich diet for patients with heart disease.

9/12/07 19:36 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.