Cost-Effectiveness of Pharmacopuncture Versus Conventional Acupuncture for Insomnia: An RCT-Based Economic Evaluation with a Markov Model

Pharmacopuncture, which combines traditional acupuncture with herbal medicine, may offer synergic therapeutic effects for insomnia management; however, evidence on its economic value remains limited. This study evaluates the cost-effectiveness of pharmacopuncture for insomnia disorder compared with other acupuncture modalities in South Korea. Two Markov models were developed from a healthcare system perspective to assess the short- and long-term cost-effectiveness of pharmacopuncture. The models included four levels of insomnia severity based on the Insomnia Severity Index (ISI). Transition probabilities, medical costs, and utility weights were derived from a pragmatic randomized controlled trial (KCT0006803). A 4-week cycle length was applied to stimulate 100 participants with moderate-to-severe insomnia. The short- and long-term models employed 8- and 24-week time horizons, respectively. Effective outcomes included the proportion of remission (ISI < 8) and quality-adjusted life-years (QALYs). Pharmacopuncture incurred an incremental cost of KRW 368,000 (USD 270) per additional remission achieved over 8 weeks. Long-term analysis showed an incremental cost-effectiveness ratio of KRW 16,940,000 (USD 12,600) per QALY. Sensitivity analyses revealed that cost-effectiveness was sensitive to pharmacopuncture pricing. Pharmacopuncture can be considered cost-effective if decision-makers accept an additional cost of KRW 400,000 (approximately USD 280) per responder over 2 months. At a willingness-to-pay threshold of KRW 27,660,000 (approximately USD 21,740), pharmacopuncture is a cost-effective option for managing insomnia compared with other acupuncture modalities. Pharmacopuncture combines acupuncture with herbal medicine and is commonly used to treat insomnia in Korea, but is not currently covered by the National Health Insurance. We conducted a clinical trial to compare pharmacopuncture with acupuncture and electroacupuncture, which are covered by insurance. We also evaluated whether pharmacopuncture provides good value for money by analyzing its costs and health effects. Pharmacopuncture led to additional costs of about USD 270 per extra patient who achieved remission over 8 weeks and USD 12,600 per quality-adjusted life year (QALY) gained over 6 months. Based on a commonly used threshold in Korea (USD 21,740 per QALY), pharmacopuncture is likely to be a cost-effective treatment compared with other acupuncture therapies. These findings suggest that pharmacopuncture could be considered for future insurance coverage, while further research may help confirm its value in broader populations.