{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:59:36Z","timestamp":1788281976823,"version":"build-2803163510"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic low back pain (cLBP) is the leading cause of disability worldwide and a major driver of healthcare costs. Excessive reliance on pharmacological treatments raises sustainability and safety concerns, highlighting the need for effective non-pharmacological alternatives. Pharmacopuncture (PPT), also known as herbal acupuncture or acupoint injection therapy, is widely practiced in some Asian countries (e.g., Korea and China) but remains uninsured in most health systems and largely excluded from international guidelines despite its clinical adoption. Evidence on its long-term cost-effectiveness compared with standard physiotherapy (PT) is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the cost-utility of PPT versus PT for patients with cLBP using a Markov model designed in accordance with international pharmacoeconomic guidelines and standard government requirements for cost-effectiveness analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A three-state Markov model (mild, moderate, severe pain) projected outcomes over 3\u202fyears with 3-month\u202fcycles. Clinical inputs were derived from a multicenter pragmatic RCT. Costs were estimated from healthcare system, restricted societal, and full societal perspectives, incorporating medical, non-medical, and productivity loss costs estimated using national health databases. Quality-adjusted life years (QALYs) were calculated using EQ-5D-5L data. Incremental cost-effectiveness ratios (ICERs) were benchmarked against the Korean willingness-to-pay (WTP) threshold. Deterministic and probabilistic sensitivity analyses assessed robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over 3\u202fyears, PPT was less costly and more effective than PT. From the healthcare perspective, PPT reduced costs ($1,304 vs. $1,385) while yielding higher QALYs (2.30 vs. 2.23), resulting in dominance (ICER\u202f=\u202f\u2212$1,145 per QALY). From the societal perspective, including productivity, PPT further strengthened its dominance ($25,760 vs. $31,962). Probabilistic sensitivity analysis showed a 97.7% (healthcare) and 99.4% (societal) probability of cost-effectiveness at the WTP threshold. Results were robust across sensitivity scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This is the first model-based economic evaluation of pharmacopuncture for cLBP. Findings indicate that PPT can deliver higher QALYs at lower costs compared with PT, underscoring its potential as a high-value non-pharmacological alternative. This aligns with WHO priorities for evidence-based integration of traditional medicine, supports policy discussions on equitable coverage, and informs sustainable chronic pain management strategies across health systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1710425","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T06:31:59Z","timestamp":1768285919000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Model-based economic evaluation of pharmacopuncture for chronic low back pain: a 3-year Markov analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Ye-Seul","family":"Lee","sequence":"first","affiliation":[{"name":"Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujin","family":"Kim","sequence":"additional","affiliation":[{"name":"Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In-Hyuk","family":"Ha","sequence":"additional","affiliation":[{"name":"Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoon Jae","family":"Lee","sequence":"additional","affiliation":[{"name":"Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e316","DOI":"10.1016\/s2665-9913(23)00098-x","article-title":"Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the global burden of disease study 2021","volume":"5","year":"2023","journal-title":"Lancet Rheumatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2697","DOI":"10.2147\/JPR.S413512","article-title":"A pragmatic randomized controlled trial on the effectiveness and safety of Pharmacopuncture for chronic lower Back pain","volume":"16","author":"Park","year":"2023","journal-title":"J Pain Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"8","DOI":"10.56986\/pim.2023.02.003","article-title":"Clinical research on pharmacopuncture in Korea: a scoping review","volume":"2","author":"Kim","year":"2023","journal-title":"Perspect Integr Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1186\/s12906-016-1288-5","article-title":"Usage report of pharmacopuncture in musculoskeletal patients visiting Korean medicine hospitals and clinics in Korea","volume":"16","author":"Lee","year":"2016","journal-title":"BMC Complement Altern Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s13020-022-00681-w","article-title":"Traditional Chinese medicine injections: where we are after 80-year development","volume":"17","author":"Zheng","year":"2022","journal-title":"Chin Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.eujim.2019.03.001","article-title":"Usage status and satisfaction with pharmacopuncture in Korea: a survey among Korean medicine doctors","volume":"27","author":"Park","year":"2019","journal-title":"Eur J Integr Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"514","DOI":"10.7326\/m16-2367","article-title":"Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians","volume":"166","author":"Qaseem","year":"2017","journal-title":"Ann Intern Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1007\/s11606-020-05871-6","article-title":"Medicare coverage of acupuncture for chronic low back pain: does it move the needle on the opioid crisis?","volume":"36","author":"Liou","year":"2021","journal-title":"J Gen Intern Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3","DOI":"10.56986\/pim.2023.02.002","article-title":"Integration of acupuncture into UK healthcare - a NICE perspective: why is acupuncture now recommended for chronic pain but not for back pain or osteoarthritis","volume":"2","author":"Cummings","year":"2023","journal-title":"Perspect Integr Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"110","DOI":"10.3831\/KPI.2024.27.2.110","article-title":"Use of herbal decoction and Pharmacopuncture in individuals with chronic disease: findings from a nationally representative panel","volume":"27","author":"Kwon","year":"2024","journal-title":"J Pharmacopuncture"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1007\/s40258-022-00721-4","article-title":"Korean guidelines for pharmacoeconomic evaluations: updates in the third version","volume":"20","author":"Bae","year":"2022","journal-title":"Appl Health Econ Health Policy"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"101210","DOI":"10.1016\/j.imr.2025.101210","article-title":"A cost-utility analysis of pharmacopuncture versus physiotherapy for chronic low back pain: a multicenter, pragmatic randomized controlled trial","volume":"14","author":"Lee","year":"2025","journal-title":"Integr Med Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e000094","DOI":"10.1136\/bmjmed-2021-000094","article-title":"Extrapolation beyond the end of trials to estimate long term survival and cost effectiveness","volume":"1","author":"Latimer","year":"2022","journal-title":"BMJ Medicine"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"100982","DOI":"10.1016\/j.imr.2023.100982","article-title":"Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: a Markov model-based analysis","volume":"12","author":"Hyun","year":"2023","journal-title":"Integr Med Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1186\/1472-6882-10-74","article-title":"An economic analysis of usual care and acupuncture collaborative treatment on chronic low back pain: a Markov model decision analysis","volume":"10","author":"Kim","year":"2010","journal-title":"BMC Complement Altern Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1097\/BRS.0000000000003539","article-title":"Update of Markov model on the cost-effectiveness of nonpharmacologic interventions for chronic low Back pain compared to usual care","volume":"45","author":"Herman","year":"2020","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1286","DOI":"10.1186\/s12913-023-10325-w","article-title":"An economic evaluation of pharmacopuncture versus usual care for chronic neck pain: a pragmatic randomized controlled trial","volume":"23","author":"Kim","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1097\/st9.0000000000000050","article-title":"Economic evaluation of Danhong injection for the treatment of chronic stable angina in China: a cost-effectiveness analysis","volume":"2","author":"Su","year":"2024","journal-title":"Sci Tradit Chin Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e42304","DOI":"10.1097\/MD.0000000000042304","article-title":"Economic impact of acupuncture for the prevention of episodic migraine and chronic migraine in Taiwan","volume":"104","author":"Wu","year":"2025","journal-title":"Medicine (Baltimore)"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"2369","DOI":"10.2147\/COPD.S374782","article-title":"Cost-effectiveness analysis of the TCM \"Yupingfeng granules\" in the treatment of acute exacerbations of COPD based on a randomized clinical trial","volume":"17","author":"Hu","year":"2022","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e2240612","DOI":"10.1001\/jamanetworkopen.2022.40612","article-title":"Trends in the use of opioids vs nonpharmacologic treatments in adults with pain, 2011-2019","volume":"5","author":"Pritchard","year":"2022","journal-title":"JAMA Netw Open"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1710425\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:18:52Z","timestamp":1769685532000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1710425\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":21,"alternative-id":["10.3389\/fpubh.2025.1710425"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1710425","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]},"article-number":"1710425"}}