On homeopathy cost studies: Nothing is always too expensive

The homeopathy advocates and also the health insurers who have included reimbursements for homeopathy in their statutory benefits like to claim that the use of homeopathy shows a cost advantage over science-based remedies and methods. Is this on sufficiently solid ground?

Already in 2015, researchers at the Charité (with the participation of the health services researcher Claudia Witt, who is unsuspicious of the disadvantage of homeopathy due to her teaching and research activities for complementary medicine) presented a rather extensive study on this: “Can Additional Homeopathic Treatment Save Costs? A Retrospective Cost-Analysis Based on 4,4500 Insured Persons“. At the time, this was the most comprehensive and long-term study of the cost-effectiveness of homeopathy. In collaboration with a well-known health insurance company. And what was the result?

“Data from 44,550 patients (67.3% females) were available for analysis. From the societal perspective, total costs after 18 months were higher in the homeopathy group (adj. mean: EUR 7,207.72) than in the control group (EUR 5,857.56) with the largest differences between groups for productivity loss (homeopathy EUR 3,698.00 vs. control EUR 3,092.84) and outpatient care costs (homeopathy EUR 1,088.25 vs. control EUR 867.87). Group differences decreased over time. For all diagnoses, costs were higher in the homeopathy group than in the control group, although this difference was not always statistically significant.”

The group with an affinity for homeopathy, half of the total study participants, thus caused about 1,350 euros per capita in additional costs over 18 months compared to the patients in the group without the use of homeopathy. That is a total additional cost of no less than 30 million euros for this group alone.

Did this result have consequences, for example, for health insurance companies, which have to observe the requirement of expediency, necessity and economic efficiency – as the Federal Social Court has clearly stated – also for services of the so-called “special therapeutic directions”? In any case, no such consequences have become apparent.

One of the points of criticism of the 2015 study was the allegedly “too short” observation period of 18 months. Now a follow-up study by Ostermann / Witt / Reinhold is available, which has extended the data basis to an observation period of 33 months (A retrospective cost-analysis of additional homeopathic treatment in Germany: Long-term economic outcomes).

Not surprisingly, the result from 2015 remained largely unchanged:

“Data from 21,939 patients in the homeopathy group (67.4% females) and 21,861 patients in the control group (67.2% females) were analysed. Health care costs over the 33 months were 12,414 EUR in the homeopathy group and 10,428 EUR in the control group. The largest cost differences were attributed to productivity losses (homeopathy: EUR 6,289 ; control: EUR 5,498 ) and outpatient costs (homeopathy: EUR 1,794; control: EUR 1,438 ). Although the costs of the two groups converged over time, cost differences remained over the full 33 months. For all diagnoses, homeopathy patients generated higher costs than control patients.”

It is noteworthy that the new study spent considerable effort to establish comparability between the groups. Homeopathic and control patients were compared on a 1:1 basis, where possible, based on the case situation. Costs (excluding baseline costs that are incurred everywhere, such as health insurance overheads and the like) were analysed between groups both across diagnoses and for targeted for specific diagnoses. Specific diagnoses included depression, migraine, allergic rhinitis, asthma, neurodermatitis and headache (i.e. classic “homeopathic indications”).

Of course, possible causes for these are conceivable over a certain range. However, it must be taken into account that the health insurance funds consistently want to address a younger, healthier clientele with their statutory benefits and naturally also expect lower expenses from this group. This obviously does not seem to work. Prospectively, this raises the question of how far this will develop to the detriment of the payers when this currently “young and healthy” clientele grows into an age group in which the utilisation of health insurance benefits inevitably follows a consistently deteriorating state of health. Then the comparison groups in a similarly designed study will probably diverge instead of converge.

It is obvious that “up-front costs” for a specifically ineffective treatment must always be ” depreciated” as pointless if, due to the severity of the clinical picture, there is a need for a follow-up treatment on an evidence-based basis. In this case, possible additional costs due to a delayed and therefore later more intensive and longer treatment would have to be added. Equally, however, an “entitlement effect” can not be completely ruled out, which results from the willingness of homeopathically oriented clients to make use of health insurance benefits even for minor health disorders. However, the magnitude of the cost differences cannot be approximately explained by this.

However, it should not go unnoticed that this is only part of the calculation of the homeopathy-reimbursing health insurance funds, which is purely aimed at the development of costs. Since the clients with an affinity for homoeopathy will also generally be high earners, the health insurance funds expect premium income in the upper possible range from a marketing point of view. This certainly makes some kind of business sense, but in view of the findings on the corresponding cost side, it remains speculation. It remains to be seen to what extent it may be questionable to use this approach to entice “good risks” away from other health insurance funds in the same solidarity system. Particularly since the system’s risk structure equalisation system will in any case partly absorb relative additional revenues. Interestingly, the studies indicate that the additional costs were largely due to above-average productivity downtimes (periods of incapacity to work) and costs for outpatient care, which at least not supports the assumption that homeopathy-affiliated insured persons had a better overall state of health.

More profound analyses are not possible because the study results were not collected in a “patient-specific” manner. However, given the broad data basis and the confirmation of the findings already made, this does not detract from the basic message: homeopathy cannot be considered “economic” even from a business perspective, especially since, as a specifically ineffective method, it can in any case be neither sufficient nor appropriate nor necessary. It thus does not fulfil a single one of the conditions under which the statutory social insurance is allowed to provide benefits according to § 12 of the Social Code. According to the insight that a price for nothing is always too high.

Updated and refined: July 2022

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