Cost-utility analysis of traditional Korean medicine without acupuncture claims versus integrative care for menopausal disorders: A nationwide retrospective cohort study

Background: Menopausal women often experience both physical and psychological symptoms, including depression, which significantly impairs quality of life (QOL). While hormone replacement therapy (HRT) and antidepressants are common treatments, concerns over side effects have increased interest in Traditional Korean Medicine (TKM), especially acupuncture. However, real-world evidence comparing integrative treatment strategies is limited. Methods: We conducted a retrospective cohort study using Korean National Health Insurance claims data (2015-2023) to evaluate the cost-utility of four treatment strategies for menopausal disorders, categorized by recorded claims for acupuncture (AP) and/or Western medicine (WM): TKM care without acupuncture claims (reference), TKM care with acupuncture claims, TKM care plus Western medicine without acupuncture claims, and TKM care plus Western medicine with acupuncture claims. Depression incidence and quality-adjusted life years (QALYs) were assessed over a 3-year horizon. Incremental cost-effectiveness ratios (ICERs) were estimated using inverse probability of treatment weighting (IPTW). Sensitivity analyses varied discount rates and utility values. Results: Among 32,941 women, the TKM care without acupuncture claims group demonstrated the lowest costs and relatively higher QALYs (2.11). All other strategies-TKM care with acupuncture claims (TKM+AP), TKM care plus Western medicine without acupuncture claims (TKM+WM), and TKM care plus Western medicine with acupuncture claims (TKM+WM+AP)-were dominated, with higher costs but slightly lower QALYs. Acupuncture users exhibited longer episode durations, higher comorbidity rates, and greater healthcare utilization, suggesting a more severe underlying patient population. Sensitivity analyses confirmed that the dominance of TKM care without acupuncture claims persisted across all scenarios. Conclusion: In this nationwide cohort, TKM care without acupuncture claims emerged as the most economically favorable strategy for managing menopausal disorders. However, the higher utilization and costs observed in integrative care groups likely reflect greater disease severity rather than inefficacy. These findings highlight the need for individualized treatment strategies and further prospective research to clarify the comparative effectiveness and cost-effectiveness of integrative approaches.