针刺治疗急性期周围性面瘫终止时机及成本效益分析的随机对照试验OA

Objective To investigate the optimal termination time for acupuncture in treating patients with acute peripheral facial paralysis and its cost-effectiveness.Methods A total of 120 eligible patients with acute-stage peri-pheral facial paralysis were randomly assigned to either the mild dysfunction termination group and the complete recovery termination group,with 60 patients in each group.Both groups received the standard acupuncture treatment protocol.Treatment in the mild dysfunction termination group was terminated when the Sunnybrook facial grade scale(SFGS)score first reached or exceeded 83 points,while that in the complete recovery termination group was terminated when the SFGS score first reached or exceeded 95 points.Assessments were conducted before treatment,6 and 12 months after onset.SFGS,facial disability index(FDI)including physical function(FDIp)and social function(FDIs),self-rating anxiety scale(SAS),and self-rating depression scale(SDS)scores were assessed before treatment,and 6 and 12 months after onset.Any acupuncture-related adverse events during treatment were recorded for safety evaluation.Treatment sessions and medical costs including direct costs,indirect costs,insurance coverage,total so-cietal costs,and patient out-of-pocket expenses were also recorded,and an economic evaluation was conducted in-cluding cost-effectiveness ratio(CER)and incremental cost-effectiveness ratio(ICER).Results Ultimately,56 patients in the mild dysfunction termination group and 55 in the complete recovery termination group completed the fol-low-up.At 6 and 12 months after onset,SFGS and FDIp scores in both groups improved significantly while FDIs,SAS and SDS scores decreased(P＜0.05).Comparison of scores between groups 6 months and 12 months after onset showed no statistically significant differences(P＞0.05).During the trial,the incidence of adverse events was 13.3％(8/60)in the mild dysfunction termination group and 18.3％(11/60)in the complete recovery termination group,with no statistically significant difference(P＞0.05).The number of treatment sessions,total social costs,and out-of-pocket expenses in the mild dysfunction termination group were significantly lower than those in the com-plete recovery termination group(P＜0.05).The CER of the mild dysfunction termination group in SFGS,FDIp,FDIs,SAS,and SDS scores was lower than that of the complete recovery termination group.The ICER analysis showed that continuing treatment until full recovery incurred an additional cost of 573.30 CNY/point in SFGS improve-ment,whereas 1-point improvement in FDIp,FDIs,SAS,and SDS required 21,355.25 CNY,1779.60 CNY,3713.96 CNY,and 2755.52 CNY,respectively.Conclusion For acupuncture in treating acute peripheral facial palsy,terminating treatment when mild dysfunction is achieved yields long-term efficacy comparable to that of continu-ing treatment until complete recovery,while significantly reducing medical costs and socioeconomic burden.