Eur J Health Econ (2014) 15:157–174
DOI 10.1007/s10198-013-0462-7
ORIGINAL PAPER
Economic evaluations of homeopathy: a review
Petter Viksveen • Zofia Dymitr • Steven Simoens
Received: 2 July 2012 / Accepted: 28 January 2013 / Published online: 10 February 2013
 Springer-Verlag Berlin Heidelberg 2013
Abstract
Context Economic evaluations of commonly used com-
plementary and alternative medicine (CAM) therapies such
as homeopathy are needed to contribute to the evidence
base on which policy makers, clinicians, health-care pay-
ers, as well as patients base their health-care decisions in an
era of constrained resources.
Objectives To review and assess existing economic
evaluations of homeopathy.
Methods Literature search was made to retrieve relevant
publications using AMED, the Cochrane Library, CRD
(DARE, NHS EED, HTA), EMBASE, MEDLINE, and
the journal Homeopathy (former British Homoeopathic
Journal). A hand search of relevant publications was carried
out. Homeopathy researchers were contacted. Identified
publications were independently assessed by two authors.
Results Fifteen relevant articles reported on 14 economic
evaluations of homeopathy. Thirteen studies reported
numbers of patients: a total of 3,500 patients received
homeopathic treatment (median 97, interquartile range
48–268), and 10 studies reported on control group partic-
ipants (median 57, IQR 40–362). Eight out of 14 studies
P. Viksveen
School of Health and Related Research, University of Sheffield,
Sheffield, UK
P. Viksveen (&)
Lindeveien 55, 4314 Sandnes, Norway
e-mail: p.viksveen@sheffield.ac.uk; homeopat@email.com
Z. Dymitr
2 St Helen’s Road, Dorchester, UK
S. Simoens
Research Centre for Pharmaceutical Care
and Pharmaco-economics, KU Leuven, Leuven, Belgium
found improvements in patients’ health together with cost
savings. Four studies found that improvements in home-
opathy patients were at least as good as in control group
patients, at comparable costs. Two studies found
improvements similar to conventional treatment, but at
higher costs. Studies were highly heterogeneous and had
several methodological weaknesses.
Conclusions Although the identified evidence of the costs
and potential benefits of homeopathy seemed promising,
studies were highly heterogeneous and had several meth-
odological weaknesses. It is therefore not possible to draw
firm conclusions based on existing economic evaluations of
homeopathy. Recommendations for future research are
presented.
Keywords Complementary and alternative medicine

Economic evaluations
Homeopathy
Cost-effectiveness
JEL Classification C18 – Methodological Issues:
General
I10 – General
I11 – Analysis of Health Care
Markets
I12 – Health Production
I13 – Health Insurance,
Public and Private
I15 – Health and Economic
Development
Introduction
The use of complementary and alternative medicine
(CAM) in the general population varies from 5 to 75 %
(median 23 %), according to a recently published system-
atic review including ten countries (Austria, Denmark,
Germany, Italy, Switzerland, United Kingdom, Canada,
United States, Australia and South Korea) [1]. A uniform,
internationally agreed definition of CAM is lacking [1].
However, the World Health Organization (WHO) has
123
158
defined CAM as: ‘‘… a broad set of health care practices
that are not part of a country’s own tradition, or not inte-
grated into its dominant health care system’’ (p. 7) [2].
Homeopathy was found to be one of the most commonly
used CAM therapies, particularly in Europe. Homeopathy
is based on the ‘principle of similars’, where a range of low
to highly diluted substances that are known to cause certain
symptoms in healthy individuals are used to treat the same
symptoms in persons who are ill [3]. So-called ‘classical’
or ‘individualised’ homeopathy involves the use of a single
homeopathic remedy adapted to each individual person.
‘Non-classical’ forms of homeopathy include the use of
either several homeopathically prepared products at the
same time, the same single homeopathic remedy for all
patients, or so-called ‘complex remedies’ where a product
consists of a combination of various substances.
A number of systematic reviews have tried to summarise
either the evidence base of homeopathy overall or in a
particular area. Three reviews of systematic reviews have
been published [4–6]. The first review identified positive
but not convincing evidence of the effectiveness of
homeopathy in most trials [4]. A second review [5] con-
cluded that collectively the identified studies: ‘‘… failed to
provide strong evidence in favor of homeopathy’’ (p. 577).
The authors of the third review [6] stated: ‘‘Taking internal
and external validity criteria into account, effectiveness of
homeopathy can be supported by clinical evidence and
professional and adequate application be regarded as safe’’
and ‘‘Reliable statements of cost-effectiveness are not
available at the moment’’ (p. 19). In summary, the overall
evidence for the effectiveness and cost-effectiveness of
homeopathy seems uncertain.
The main cost involved in homeopathic treatment is the
cost of the consultation with the homeopath, with a first
consultation often lasting at least 1 h and a follow-up
consultation lasting 20 min or more. Costs of homeopathic
medicinal products are lower than those of most conven-
tional drugs. The costs that can be considered when eval-
uating homeopathic treatment include direct costs (e.g.
practitioner fees and costs of homeopathic medicines), non-
medical costs (e.g. transportation) and indirect costs (e.g.
productivity loss associated with work absence or reduced
productivity at work).
Cost-effectiveness in health care is of major concern to
individuals, employers, national governments and society
at large in an era of constrained resources. Claims have
been made stating that complementary and alternative
medicine (CAM) in general and homeopathy in particular
are cost-effective treatment modalities [7, 8]. The aim of
this publication is to assess economic evaluations of
homeopathic treatment by reviewing the results and
methodological quality of economic evaluations of home-
opathy published to date. The authors of a health
123
P. Viksveen et al.
technology assessment published in 2006 identified only
three studies assessing costs in combination with quality of
life measures and concluded that reliable documentation of
the cost-effectiveness was not currently available [6]. We
add to the existing literature by providing a more complete
review including a larger number of identified studies and
offering a more thorough description of existing research
evidence. The relevance of the findings is discussed and
gaps in the evidence base are identified.
Methodology
A literature search was carried out in February 2011 and
updated in April 2012, identified through AMED, the
Cochrane Library, EMBASE and MEDLINE databases, as
well as a search of one of the major homeopathy research
journals, Homeopathy (former British Homeopathic Jour-
nal). Moreover, a search of the Centre for Reviews and
Dissemination databases (DARE, NHR EED, HTA) was
carried out in July 2011 and updated in April 2012. Data-
base searches were made for variations of the words
‘homeopathy’ and ‘cost’, using the Boolean operator
‘‘AND’’ and wildcard symbols as appropriate for each
database. The journal Homeopathy was searched for the
word ‘cost’. All identified titles were considered and all
articles considered relevant were included in the analysis.
No time or language limitations were set.
The following inclusion/exclusion criteria were used:
reports of economic evaluations of homeopathy used in
treatment of humans. An economic evaluation was defined
as a study contrasting an intervention with a comparator in
terms of both costs and consequences [9]. The intervention
was homeopathic treatment. Studies assessing CAM treat-
ment but not specifying results for homeopathy were
excluded. The comparator could range from ‘do nothing’ or
placebo, to conventional drug treatment or other health
intervention. Studies assessing results from before to after
homeopathic treatment were also included, using data from
before treatment start as a comparator. Inclusion was
restricted to articles published in peer-reviewed journals.
Congress abstracts were not considered because they do not
provide sufficient details of methodology and results.
Articles were excluded if studies analysed a single inter-
vention without a comparator and if data on either costs or
consequences were absent.
The quality of economic evaluations was assessed by
using the most relevant parts of the Cochrane Consumers
and Communication Review Group’s data extraction tem-
plate [10], perspective (i.e. society or third-party payer),
study design (i.e. research design and type of economic
evaluation); source of clinical and economic data; cost and
consequence measures; time horizon; allowance for
Economic evaluations of homeopathy
uncertainty (i.e. sensitivity analysis); and incremental anal-
ysis of costs and consequences (i.e. calculation of ICER).
Risk of bias was assessed according to the Cochrane
Handbook for Systematic Reviews of Interventions [11].
Studies were assessed by one reviewer and interpreta-
tions were checked by a second. An inclusion/exclusion and
data extraction form was completed for each study. Eco-
nomic evaluations were summarised by focussing on the
study country, type of study and type of economic evalua-
tion (i.e. cost-effectiveness analysis, cost-minimisation
analysis, cost-utility analysis, cost-benefit analysis), sam-
ple, intervention, comparator, costs and consequences
results. Any disagreements between the two reviewers were
resolved by a third reviewer and, if there was still no con-
sensus, this was cleared through discussion within the
research team. In practice, this was not required. Due to the
heterogeneity of the primary studies, a descriptive synthesis
of the extracted data was made. The characteristics and the
results of the included studies were summarised via tabu-
lation. To compare costs between studies, costs were actu-
alised to 2012 values using a rate of annual average inflation
based on the evolution of the Consumer Price Index. Costs
were converted using US dollar exchange rates.
Results
Search results
A literature search resulted in a total of 868 titles
(including duplicates) (Fig. 1). After removal of duplicates,
496 titles remained. Each individual title was considered
Records identified through
database searches identified through other
n=868
Records after duplicates
(n=374 ) removed
n=496
Records assessed
n=496
Studies included
n=15
Fig. 1 Flow of information in the review
159
for relevance, and when there was doubt the abstract or full
article was considered. The assessment process helped to
identify 15 relevant articles reporting on 14 studies, which
were included in this review [12–26]. Three titles were
found in one source only, including the AMED (1 title) and
through a hand search (2 titles). The remaining articles
were identified through more than one source. The studies
included economic evaluations based on clinical trials,
observational studies, case and insurance company reports
including various ways of presenting costs and conse-
quences of homeopathic treatment.
Results of studies
Numbers of studies and types of methodologies
The 14 studies (16 articles) (Table 1) included in this
review considered various aspects of the costs and conse-
quences of homeopathic treatment [12–26]. Twelve studies
(13 articles) compared the results of homeopathic treatment
with other treatment or placebo [12–14, 16–19, 21–26].
Comparators were mainly conventional treatment, with one
study also comparing results with acupuncture [17] and
another with placebo [15]. Two studies used a before-to-
after treatment design for comparison of results [19, 20].
Thirteen articles reported on 12 cost-effectiveness
analyses [13, 14, 16–26], and the remaining two were a
cost-minimization [12] and a cost-utility analysis [15]. This
included three randomised controlled trials [15, 17, 21],
four articles reporting on three cohort studies [16, 22, 23,
25], two case series [19, 20], two uncontrolled parallel-
group studies [18, 26] and two other uncontrolled studies
Additional records
sources n=2
Records excluded,
with reasons
n=481
Animal & plant studies n=19
Congress abstracts n=20
No costs or consequences n=113
Not homeopathy n=79
Not research n=156
Planned study n=3
Reviews n=89
Single case s n=2
123
 Table 1 Studies considering economic evaluations of homeopathy
160

Author, Study sample Intervention Comparator Economic Perspective Resultsa Comments strengths Comments
year N = 3,512 N = 151,955 evaluation and study of economic weaknesses

123
type evaluation
and time
horizon

Bachinger Osteoarthritis Injections of Hyaluronic Cost-minimisation Perspective: Zeel comp. USD 950/patient. Success Reported: direct health-care Direct non-
et al. of the knee Zeel comp. acid analysis (non- societal in 26 of 57 patients. Quality- costs: medication (main health-care
[12], (combination injections inferiority design) Time adjusted cost USD 2,084 per cause of difference in costs: travel
Germany product) (n = 57) based on model horizon: successfully treated patient (pain costs); appropriate time expenses
(n = 57) calculation 12 months reduction min. 30 %) horizon Comparison with mentioned,
(methodology Hyaluronic acid USD 1,934/patient. existing treatment but figures not
unclear) Success in 34 of 57 patients. reported;
Quality-adjusted cost USD 3,242 per Indirect costs:
successfully treated patient work
Zeel comp. costs 50.9 % lower than disability
hyaluronic acid costs. Quality- mentioned,
adjusted cost difference: Zeel comp. but figures not
35.7 % lower costs than hyaluronic reported
acid costs per successfully treated No baseline
patient (costs of all patients divided data;
amongst successfully treated Details of study
patients) methodology
insufficiently
reported;
No blinding
mentioned;
Insufficient
information on
assessment
method and
time of
assessment;
No sensitivity
analysis
P. Viksveen et al.
 Table 1 continued
Author, year Study sample Intervention Comparator Economic evaluation and study Perspective Resultsa Comments Comments
N = 3,512 N = 151,955 type of economic strengths weaknesses
evaluation
and time
horizon

Feldhaus [13], Dental surgery, Arnica montana D12 Other dental Cost-effectiveness analysis based Perspective: 55 % reduction in postoperative Reported: direct Indirect costs:
Germany patients with (single remedy) for practices, on data in a single practice with insurance treatments from before to after health-care sick-leave
compulsory 3 days prior to and statistics all consecutive patients collected companies introduction of Arnica in surgery costs: mentioned, but
health 7 days after provided by and compared to figures provided Time Costs 40 % lower compared to other postoperative figures not
insurance, surgical treatment dental by dental association for all horizon: dental practices. Insurance companies’ treatment costs presented;
single dental (n not reported) association dental practices unknown. costs for postoperative treatments Some comparison Direct non-health
Economic evaluations of homeopathy

practice (n not Data reduced by USD 1,267 annually. 37 % of results with care costs not
reported) collection sick-leave reduction, 40 % below other figures for other reported
period: dental practices practices Single practice;
7 years presented by
dental Not RCT;
association Unclear whether
this practice is
otherwise
comparable to
other practices;
Time horizon not
reported;
Unclear if other
practices
offered same
treatment;
No sensitivity
analysis
Frei and Acute otitis Individualised Comparison Cost-effectiveness analysis based Perspective: 39 % free of pain within 6 h, 72 % Reported: direct Costs other than
Thurneysen media in homeopathy with other on an unontrolled clinical trial unclear within 12 h. Resolution of pain 2.4 health-care medication and
[14], patients aged (n = 230) studies (n not (particpiants given conventional Time times faster than placebo. No costs: consultations
Switzerland 0–16 years, reported) treatment in case of non-response horizon: complications medication and not reported
single to homeopathic treatment) 12 h Homeopathic treatment 14 % cheaper consultations Single practice;
pediatric than conventional treatment:
practice Not RCT;
homeopathy USD 114, conventional
USD 132 per patient Comparison with
control group
from another
study
considerably
reduces validity
of results;
Very short time
horizon;
No sensitivity
analysis
161

123
 Table 1 continued
162

Author, year Study sample Intervention Comparator Economic evaluation Perspective Resultsa Comments strengths Comments
N = 3,512 N = 151,955 and study type of economic weaknesses

123
evaluation
and time
horizon

Kneis et al. Acute maxillary Complex Placebo Cost-utility analysis Perspective: Compared to antibacterials Reported: direct health-care Apart from
[15], sinusitis in HMPb (n = 56) based on RCT societal Sinfrontal cure rate 59 versus 11 % for costs: medication; medication costs
Germany consecutive (sinfrontal) Conventional Time antibacterials (p \ 0.001) at similar or lower Indirect costs: work and work
patients in a (n = 57) treatment horizon: costs (22-day period) absenteeism absenteeism, no
single GP (n not other costs
practice 11 weeks Over 22 days Results robust to sensitivity reported
reported) analyses
Incremental savings USD 404 (95 % CI 151–636) Single practice;
per patient compared to placebo, primarily due
to work absenteeism (7.83 vs. 12.9 workdays) No long-term
assessment
Incremental utility 0.0087 QALYs (95 % CI
0.0052–0.0123) or 3.2 QALDs
Over 11 weeks (8 weeks post-treatment
observation):
Sinfrontal: incremental cost savings of USD 751,
utility gains of 0.015 QALY or 5.4 QALDs
compared to placebo
Kooreman Various patients, Homeopathy Conventional Cost-effectiveness Perspective: Homeopathy GP patients had reduced mortality Reported: direct health-care Non-direct health-
and Baars 28 (approach treatment based on a cohort insurance (p \ 0.05) costs: GP care, hospital care costs and
[16], The homeopathy not (n = 151,955) study (data from a company Substantially lower health-care costs (15 %) for care, pharmaceutical non-health-care
Netherlands GPs compared reported) single health Time all age groups below 75 (p \ 0.05). Lower costs care, paramedic care (e.g. costs not reported
to other GPs’ (n = 1,182) insurance horizon: resulted from reduced prescription drug costs physical therapy); No RCT;
Health insurance company) and fewer hospital stays. Differences unrelated Time horizon allows for
4 years limited data set
data to socioeconomic status long-term assessment (only one health
Relatively large sample insurer);
size, in particular for Potential self-
comparator; selection bias
Several practitioners (more health-
included; conscious patients
Reported on mortality; choose
homeopathy/
Linear and loglinear CAM);
regression analysis
included Not assessed:
morbidity,
subjective health
P. Viksveen et al.
 Table 1 continued
Author, Study sample Intervention Comparator Economic Perspective of Resultsa Comments Comments
year N = 3,512 N = 151,955 evaluation and economic strengths weaknesses
study type evaluation and
time horizon

Paterson Dyspepsia, Individualised Conventional Cost-effectiveness Perspective: Symptom improvement (MYMOP) in all three groups at Reported: direct Other than
et al. single clinic homeopathy treatment analysis based societal 6 weeks, 3 and 6 months. No further change from 6 to health-care medication and
[17], UK (n = 21) (n = 19) on pragmatic Time horizon: 12 months. No between-group differences costs: consultation costs,
Acupuncture RCT Wide variations, but no statistically significant differences medication and no other costs
(n = 20) 6 months (some consultation reported
data 12 months in consultation and prescription costs. Costs per patient
over 6 months (mean/SD): homeopathy USD 216 (68), costs; Single practice;
after treatment
end, at acupuncture USD 360 (107), GP consultations USD 16 Appropriate time Small sample size;
Economic evaluations of homeopathy

18 months) (37) and prescriptions USD 132 (150) horizon

Heterogeneity of
Pragmatic RCT study sample, low
intensity and high
variability of
symptoms;
High degree of
comorbidities with
a variety of
medications
Pomposelli Diabetic Individualised Conventional Cost-effectiveness Perspective: Diabetic neuropathy symptoms and quality of life Reported: direct Costs other than for
et al. neuropathy, homeopathy treatment analysis based societal improved significantly only in the homeopathy group health-care medication not
[18], Italy single clinic (n = 32) (n = 29) on uncontrolled Time horizon: (p = 0.016). Objective measures were stable in both costs: reported
with 4 MDs parallel-group groups medication; No RCT;
study 12 months
First 6 months’ costs for conventional drugs reduced by Appropriate time Small sample size;
USD 181 (USD 30/month) in the homeopathy group horizon;
(p = 0.078) compared to a USD 89 (USD 15/month) Potential patient self-
Blinded selection bias;
increase in a control group (p = 0.139), a difference of assessment
USD 270 (USD 45/month) (p = 0.071) Baseline drug-
For the 12-month period: USD 66 (USD 5.5/month) consumption
(p = 0.432) reduction for homeopathy and USD 161 differences (higher
increase for the control group (USD 13/month) for homeopathy)
(p = 0.074), a difference of USD 227 (19/month) (p = 0.007)
(p = 0.089)
Sevar [19], Various Individualised Before to after Cost-effectiveness Perspective: 67 % improved, 61 % improved to such a degree that it Reported: direct Costs other than for
UK chronic homeopathy treatment analysis based patient affected their daily living (9-point self-report numerical health-care medication not
complaints, (n = 455) (n N/A) on prospective Time horizon: rating scale) costs: reported
single case series Total cost savings per year USD 11,295 (USD 77 per medication; No RCT;
homeopathy 11 months (mean)
patient). Previously prescribed conventional drugs were Appropriate time No control group;
clinic discontinued in 33 % horizon
No sensitivity
Larger sample analysis
size;
Similar to
‘regular’
homeopathy
practice (higher
external
validity)
163

123
 Table 1 continued
164

Author, Study sample Intervention Comparator Economic Perspective Resultsa Comments strengths Comments
year N = 3,512 N = 151,955 evaluation and of economic weaknesses

123
study type evaluation
and time
horizon

Slade [20], Various complaints Homeopathy Before to after Cost- Perspective: Significant improvement in primary and Reported: direct health-care costs: Costs other than
UK (mainly arthritis, (approach not treatment effectiveness societal secondary symptoms, ability to medication; for medication
depression, anxiety, skin reported) (n N/A) analysis time undertake activities and well-being appropriate time horizon not reported;
complaints), (n = 97) based on horizon: measured with MYMOPc at mean Medication cost
prospective 12 months follow-up of 134 days (p \ 0.0001). Several practitioners;
single GP practice with calculation
patients referred from 8 case series Improvement in complaints was similar to ‘regular’ homeopathy based on 1 year
GP practices reported by 80 % of patients and practice (higher external validity) of consumption
well-being by 76 % (might not have
Costs of conventional drugs: been the case for
71 of 97 patients were taking some)
conventional drugs at trial start, 57 % No RCT;
(n = 28 of 49 who provided No control group;
information on costs) stopped or
reduced conventional medication. Single practice;
Cost savings USD 5,519 (n = 22 No sensitivity
patients, savings USD 252 per patient analysis
per year)
Thompson Children with severe Individualised Usual care Cost- Perspective: No between-group differences, except Reported several aspects allowing Small sample size
et al. asthma, single doctor in homeopathy (conventional effectiveness societal better morning and afternoon peak for cost-effectiveness analysis: (pilot study);
[21], UK hospital outpatient (with some treatment in analysis and patient flow in favour of usual care, with direct health-care costs: Single
department, recruited isopathy) in respiratory based on Time patients taking more and higher doses medication, consultations, practitioners;
from two secondary care addition to hospital pragmatic horizon: of conventional medication secondary hospital care,
respiratory hospital usual care clinics) RCT ambulance services; indirect No long-term
4 months NHS costs significantly higher in assessment;
clinics (n = 18) (n = 21) homeopathy group, mainly because of costs: work absenteeism;
consultations, mean difference USD Direct non-health care: patients’ Lower external
1,129 (95 % CI 257–2,001). Non- travel expenses; validity due to
significantly higher costs in personal pathology more
Pragmatic RCT; severe than in
(patient) costs, mean difference USD
156 (95 % CI -84–396) Higher model validity because of regular practice)
practitioner with high competence
in homeopathic treatment of this
patient group
P. Viksveen et al.
 Table 1 continued
Author, year Study sample Intervention Comparator Economic Perspective Resultsa Comments Comments weaknesses
N = 3,512 N = 151,955 evaluation and of economic strengths
study type evaluation
and time
horizon

Trichard et al. Children with ear, nose Homeopathy Conventional Cost- Perspective: Homeopathy resulted in a lower Reported: No costs reported for work
[22, 23], and throat infections, (approach not 62 GPs effectiveness societal number of episodes of rhino- direct health- absenteeism;
France 135 GP practices reported), (n = 231) analysis and patient pharyngitis and complications care costs: Direct non-health-care costs not
73 GPs based on Time compared to conventional treatment medication, reported;
(n = 268) cohort study horizon: (p \ 0.001) tests,
consultations; Unknown time horizon
unknown Overall direct costs were the same in
No RCT;
Economic evaluations of homeopathy

Data the homeopathy (USD 276) and Indirect costs:

collection antibiotics groups (USD 272) work Potential selection bias: homeopathy
period: (p [ 0.05), with lower costs to social absenteeism patients less likely to be exposed to
6 months security for homeopathy (USD 139) mentioned passive smoking (p \ 0.001), less
compared to antibiotics (USD 157) Higher external likely to be at home daytime
(p \ 0.05), but higher costs to validity due (p = 0.02), more likely to be from
patients for homeopathy (USD 136) to large ‘blue/white-collar employment’
compared to antibiotics (USD 115) number of families (p \ 0.001);
(p \ 0.05). Differences in costs were practitioners Homeopathy vs. antibiotics: risk of
due to consultations, and not drugs unequal distribution of confounding
and tests factors (both groups received other
Indirect costs: number of parents who drugs)
missed days of work was lower in No sensitivity analysis
the homeopathy group (13 %) than
in the control group (27 %)
(p = 0.001). Homeopathic GPs
initiated preventive treatment in
82 % and antibacterials in 21 %;
non-homeopathic GPs preventive
43 %, antibacterials in 90 %
van Various compaints Individualised Conventional Cost- Perspective: Physical complaint better 89 %, Reported: Costs other than for medication and
Wassenhoven (most common CNS homeopathy treatment, effectiveness patient moderately or much better 57 %, direct health- consultation not reported
and Ives [24], and respiratory (mostly) data obtained analysis Time psychological better 78 %, care costs: No RCT;
Belgium complaints, 78 % (n = 782) (10 from national based on horizon: moderately or much better 48 %, medication,
with severity consecutive statistics on cross- satisfaction 95 % consultation; potential selection bias;
affecting daily patients in 14,000 GP sectional 9 years Insufficient inter-rater reliability
Costs were significantly lower than for Time horizon
living), 80 GP each practice) pactices survey (mean conventional treatment: consultation allows for (patients’ and practitioners’ ratings);
practices treatment costs were reduced by 22 % and long-term No sensitivity analysis
period) prescriptions costs (including assessment
conventional medication) were 1/3 Higher external
of GP average (subset of data from validity due
47 GPs). Previously prescribed to larger
conventional drugs were number of
discontinued in 52 % practitioners;
Comparison
with large
number of
other
practices
165

123
 Table 1 continued
166

Author, Study sample Intervention Comparator Economic Perspective Resultsa Comments strengths Comments
year N = 3,512 N = 151,955 evaluation and of economic weaknesses

123
study type evaluation
and time
horizon

Witt et al. Patients suffering from various
[25], chronic complaints (headache,
Germany lower back pain, depression,
insomnia, sinusitis, asthma,
atopic dermatitis, allergic
rhinitis), 160 physicians
Individualised Conventional Cost- Perspective: Symptom severity (patient assessed): Reported several types of costs Direct non-
homeopathyd, treatment, effectiveness insurance homeopathy significantly better than including: direct health-care health-care
101 GPs 59 GPs analysis company conventional treatment for adults costs: medication, costs not
(n = 265) (n = 228) based on Time (p = 0.002) and children (p = 0.029) consultations, hospital care, reported
comparative horizon: Symptom severity (physician assessed): physiotherapy care No RCT;
parallel- improvement in both groups Indirect costs: work
group cohort- 12 months Potential
(p \ 0.001), but no between-group absenteeism; selection bias
study difference in adults (p = 0.251), but Appropriate time horizon (but adjusted
significant between-group differences in analysis);
favour of homeopathy in children Higher external validity due to
(p \ 0.001) the large number of Small sample
practitioners and patients size for cost-
No between-group differences in with a variety of complaints effectiveness
physicians’ overall assessed therapeutic representative of general analysis (cost
success or satisfaction homeopathy practice; analyses
Quality of life (physical): homeopathy Adjusted analysis to reduce Only for
significant improvement first 6-month bias due to between-group subgroup);
period and better compared to differences
conventional (p = 0.016), not the Potential
second 6-month period (p = 0.649), detection bias
conventional no change. Quality of life (non-blinded
(mental): no changes/differences severity
rating)
No significant difference in treatment costs
between homeopathic and conventional
treatment groups, except for adults
whose medication costs were higher for
conventional compared to homeopathic
treatment. Overall costs for homeopathy
USD 3,359, conventional USD 3,138
(p = 0.856) for adults, and homeopathy
USD 2,293, conventional USD 1,225
(p = 0.137) for children
P. Viksveen et al.
 Table 1 continued
Author, Study sample Intervention Comparator Economic evaluation Perspective Resultsa Comments strengths Comments
year N = 3,512 N = 151,955 and study type of economic weaknesses
evaluation
and time
horizon

Witt et al. Atopic eczema Individualised Conventional Cost-effectiveness Perspective: No significant between-group differences in Reported several types of costs Not reported direct
[26], in children homeopathy treatment analysis based on societal atopic dermatitis score (SCORAD) including: direct health-care non-health-care
Germany (1–14 years), by 10 by 16 uncontrolled multi- Time (p = 0.290/0.974 at 6 and 12 months), costs: medication, consultations, costs
26 physicians physicians physicians centre parallel group horizon: QoL similar hospital care; indirect costs: No RCT;
(n = 48) (n = 87) prospective study 12 months Significantly reduced use of conventional work absenteeism;
Potential self-
drugs in homeopathy group (similar at Higher external validity due to selection bias:
Economic evaluations of homeopathy

baseline) large number of practitioners between-group

Adjusted costs higher in homeopathic than and complaint commonly treated baseline
conventional group: in homeopathy practice; differences (but
First 6 months: Blinding of assessors; adjusted analysis);
Homeopathy USD 1,335, Adjusted analysis to reduce bias in Small sample size
between-group baseline (underpowered,
Conventional USD 734 (p = 0.026) differences recruited 56 %);
12 months: Potential recall bias
Homeopathy USD 2,176 (95 % CI (patients’ recall
1,711–2,642) complemented by
Conventional USD 1,030 (95 % CI physicians’ data)
607–1,454)
(p = 0.001)
Differences were due to higher costs of
consultations (p \ 0.001), medical aids
and adjuvant therapies (p = 0.004).
Differences in indirect costs were non-
significant (p = 0.652)
a
Main findings are here not necessarily what was defined as the main findings by the authors of the publications, but the main findings that are of relevance to this review. Results adjusted for inflation rates from
publication date to 2012 level http://www.inflation.eu/. Change from German mark to euro on 1 January 1999 (1 EUR = 1.95583 DM) http://en.wikipedia.org/wiki/Euro. Currency conversion rates on 13 March 2012 (1
CHF = 1.08368 USD, 1 EUR = 1.30663 USD, 1 GBP = 1.56787 USD) http://www.xe.com/ucc/
b
HMP homeopathic medicinal product
c
MYMOP measure yourself medical outcome profile
d
Personal communication 11.01.2011
167

123
168
[13, 14], a cross-sectional study [24] and one study not
specifying the used methodology [12].
Overall results and methodological quality of studies
Out of a total of 14 identified studies, 8 reported
improvements in patients’ complaints and/or state of
health, together with some sort of cost savings [12–16, 19,
20, 24]. In four studies (5 articles) clinical outcomes for
homeopathy were either better than [18, 25] or as good as
those in controls [17, 22, 23, 25], at similar costs. In the last
two studies, clinical results were similar to those in con-
trols, but at higher cost in the homeopathy group [21, 26].
The time horizon varied considerably, from only 12 h to
several years, with most studies being assessed over at least
6 months. Even though the overall results of this review of
economic evaluations of homeopathy may seem promising,
studies were highly heterogeneous and mostly of low
methodological quality, preventing any firm conclusions
from being drawn. It is, from a theoretical perspective, not
possible to determine a priori whether methodological
issues/limitations will under- or overestimate differences in
costs and outcomes.
Although case series were mostly prospective and
included consecutive patients, this methodological
approach serves as weak evidence, as there are consider-
able risks of results being influenced by confounding fac-
tors and improvements may (at least in part) be the result of
fluctuations in patients’ state of health and regression to the
mean effects. This is also true for any other non-random-
ised methodological approach. Another question is whether
homeopathy patients are different from the general popu-
lation, e.g. in terms of having less serious disease. This is
however unlikely, as patients more often consult with a
homeopath after having suffered from chronic disease for a
longer period of time and often first tried conventional
care.
For comparison of results with data from other studies or
other practices, results were in most cases not adjusted for
participants’ characteristics [13, 14, 24]. An exception was
a cohort study where results were compared to a large
comparison group [16]. In this study linear and log linear
regression analysis showed that age (which was higher in
the homeopathy group) and socioeconomic status (which
was lower in the homeopathy group) affected the results.
However, it is still possible that factors other than
homeopathic treatment may have influenced results.
Examples could be participants’ health consciousness, and
thereby their lifestyle, or practitioners’ tendency to give
advice on prevention of disease. Moreover, results of this
study were from a single insurance company and results in
half of the identified studies were from a single homeop-
athy practice, which raises the question of generalisability
123
P. Viksveen et al.
to the wider population. Overall, transferability of results to
other settings was uncommon, and discussion of transfer-
ability to other countries was not found.
A variety of outcome measures were used in the iden-
tified studies. Many outcome measures are related to
intermediate outcomes (e.g. reduction in diabetic neurop-
athy symptoms) rather than final outcomes (e.g. health
status or quality of life). The impact of homeopathic
treatment on quality of life was only assessed in a limited
number of studies [18, 25, 26]. With one exception that
reported on ‘treatment’ [13], all studies reported specifi-
cally on costs of medication, with four studies solely
reporting on costs of medication [12, 18–20]. Costs of
consultations, which commonly are higher than costs of
medication in homeopathic treatment, were included in 8
out of 14 studies [14, 16, 17, 21–26].
Only four studies included hospital [16, 21, 25, 26] or
other [16, 25] care costs. Only two studies considered
direct non-health care costs (transportation to consulta-
tions) [12, 21], one of which did not specify these costs
[12], and another that did not find significant differences
in costs between homeopathy and conventional care for
costs of travel to primary and secondary care visits [21].
Other non-health care costs included work absenteeism,
which was mentioned in seven studies (8 articles) [12, 13,
15, 21–23, 25, 26]. Out of these, three reported reduced
sick leave, but no financial consequences of it [13, 15, 22,
23]; one stated that these costs were low compared to
direct costs [12]; one registered sick-pay, but did not
report results of this separately [25]; and two did not find
that the number of sick-leave days or costs of work-
absenteeism were significantly different from conven-
tional treatment [21, 26]. No other non-health-care costs
were considered.
Because studies employed multiple outcome measures
and did not combine them into a single index, in most
cases, it was not possible to get an idea of the overall cost-
effectiveness of homeopathic treatment. It was not relevant
to present incremental cost-effectiveness ratios or incre-
mental cost-benefit ratios, as no study reported greater
improvement at higher costs compared to comparators.
Few studies allowed for uncertainty, with only four
studies [15, 16, 25, 26] conducting sensitivity analyses to
account for uncertainty around key estimates and
assumptions made during the identification, measurement
and valuation of costs and outcomes.
Other quality problems included insufficient information
on research methodology and/or methodology used for
economic evaluation, potential selection and recall bias,
small sample sizes or lack of sample size calculation, lack
of or differences in baseline data with heterogeneity of
study samples, insufficient information on assessment
methods and lack of blinding of assessors.
Economic evaluations of homeopathy
Numbers of participants and types of complaints
In 13 out of the 14 studies, homeopathic treatment was
given to a total of 3,512 patients, with a median number of
97 participants (interquartile range 40–362, range
18–1,182) [due to skewed data the median and interquartile
range (IQR) are presented]. One study did not report the
number of participants [13]. The median number of
patients in control groups was 57 (IQR 34–230, total
151,955) in the nine studies (10 articles) where this was
reported [11, 15–18, 21–23, 25, 26].
Five studies [16, 19, 20, 24, 25] considered costs and
consequences for a total of 2,781 homeopathy patients
suffering from various complaints (comparison group total
over 152,000) [17, 27] and four (5 articles) [14, 15, 21–23]
in respiratory and ear complaints for a total of 573 home-
opathy patients (comparison 287) [15, 21–23]. The five
remaining studies considered homeopathy for patients
suffering from atopic dermatitis (homeopathy 48/compar-
ison 87) [26], diabetic neuropathy (32/29) [18], dyspepsia
(21/39) [17], osteoarthritis of the knee (57/57) [12], and
dental complaints (numbers not reported) [13].
Time horizon
The time horizon was 11 or 12 months for six studies [12,
18–20, 25, 26], about 3–6 months for three studies [15, 17,
21], only 12 h in one study [14], and 4 [16] and 9 years
[24] for the longest studies. The time horizon was unknown
in two studies, but data collection was carried out over
6 months in one of them [22, 23] and 7 years in another
[13]. Most studies took the societal perspective (details in
Table 1).
Numbers of practitioners and countries
In six of the studies treatment was provided by a single
homeopathy practitioner or clinic [13–15, 17, 19, 21]. The
remaining studies included from 4 to 101 homeopaths or
homeopathy clinics [16, 18, 20, 22–26], and one study did
not report the number of practitioners [12]. Only four
studies (5 articles) reported on the number of practitioners
in comparison groups, ranging from 16 to 14,000 [22–26].
Five studies were carried out in Germany [12, 13, 15,
25, 26], four in the UK [17, 19, 21], and one in each of the
following countries: Belgium [24], France [22, 23], Italy
[18], the Netherlands [16] and Switzerland [14].
Types of homeopathy
Eight studies involved mainly classical homeopathy, with a
total of 1,851 patients (median 139, IQR 27–360) [14, 17–
19, 21, 24–26], three studies applied non-classical methods
169
where all participants were prescribed the same product
(two complex, n = 114) [12, 15] (one single HMP, n not
reported) [13]. The remaining three studies (4 articles),
with a total of 1,547 participants, did not specify the
homeopathic approach [15, 20, 22, 23].
Studies assessing homeopaths’ treatments of patients
with various complaints
Five studies reporting on patients with various complaints
included cost-effectiveness analyses based on two case
series [19, 20], two cohort studies [16, 25] and a cross-
sectional survey [24]. Two case-series were carried out in
single practices with a total of 552 patients assessed over
an 11–12-month period [19, 20]. Patient self-reported
improvements were found in 67 % [19] and 80 % [20] of
patients from before to after treatment, with improvements
in 61 % [19] affecting daily living and 76 % [20] experi-
encing improved well-being. In one of these studies [20],
patients’ self-reported MYMOP scores [27] showed sig-
nificant improvements in primary and secondary symp-
toms, ability to undertake activities and well-being at a
mean follow-up period of 134 days (p \ 0.0001). The
other study used a 9-point numerical rating scale [19].
Based on reduction in consumption of conventional drugs,
annual savings were calculated to $ 78 or $ 252 per patient
[19, 20]. No other costs were reported.
An economic evaluation by Van Wassenhoven and Ives
[24] was based on a cross-sectional survey including 782
consecutive patients suffering from various complaints
who had received mostly classical homeopathic treatment
provided by 80 general practitioners (GPs) for an average
period of 9 years. Results showed improvement in physical
complaints in 89 % of patients (57 % moderately/much
better) and in 78 % for psychological complaints (48 %
moderately/much better), with 95 % saying they were
satisfied with the treatment. Costs were significantly lower
as compared to 14,000 conventional GP practices (con-
sultation costs 22 % lower, prescription costs 1/3 of con-
ventional GPs). No other costs were reported.
Witt et al. [25] carried out an economic evaluation based
on a parallel-group cohort study of 265 patients suffering
from various complaints who received classical homeo-
pathic treatment from 101 GPs compared to results in 228
patients receiving conventional treatment from 59 GPs
over a 12-month period. Patient-assessed improvement was
significantly better for homeopathy compared to conven-
tional treatment for both adults (p = 0.002) and children
(p = 0.029). Physicians’ assessment of symptoms was
better for children in the homeopathy group (p \ 0.001),
and both the homeopathy and the conventional adult
group’s symptoms improved (p \ 0.001), but without
between-group differences (p = 0.251). There was no
123
170
between-group difference in physician overall assessed
therapeutic success or satisfaction. Physical quality of life
improved significantly for the homeopathy group over the
first 6 months (p = 0.016), but not for the next six
(p = 0.649), and no changes were found for mental quality
of life. Adults’ medication costs were higher in the con-
ventional compared to the homeopathic group, but overall
treatment costs were similar for the two groups (p = 0.856
for adults, p = 0.137 for children). The scope of the cost
analysis included medication, consultations, hospital care,
physiotherapy care and work absenteeism.
An economic evaluation by Kooreman and Baars [16]
was based on a cohort study comparing results for 1,182
patients treated with homeopathy for various complaints in
28 GP practices with over 150,000 patients in regular GP
practices over a 4-year period. Results showed reduced
mortality in homeopathy patients (p \ 0.05) and 15 %
lower health-care costs (p \ 0.05) resulting from reduced
drug prescriptions and hospital expenses. Direct health-
care costs included GP, hospital, pharmaceutical and
paramedic care.
Studies assessing homeopaths’ treatment of patients
with respiratory tract and ear complaints
Four studies (5 articles) [14, 15, 21–23] in respiratory tract
and ear complaints included cost-effectiveness analyses
based on an uncontrolled clinical trial [14] and a cohort
study [22, 23], and a cost-effectiveness analysis [21] and a
cost-utility analysis [15] based on randomised controlled
trials.
The shortest study (assessed at 12 h) found 2.4 times
faster resolution of pain in acute otitis media in 230 chil-
dren treated with classical homeopathy compared to con-
ventionally treated children in other studies [14]. Costs of
consultations and medication were 14 % lower in the
homeopathy group (homeopathy $ 114 and conventional
$ 132 per patient). No other costs and no long-term results
were reported.
An economic evaluation by Kneis and Gandjour [15]
was based on a randomised placebo-controlled trial of
acute maxillary sinus infections treated with a standardised
complex homeopathic medicinal product (n = 57) or pla-
cebo (n = 56). Homeopathy patients had a cure rate of
59 % compared to 11 % for anti-bacterials (n not reported)
(p \ 0.001) at similar or lower costs over a 22-day period.
Incremental savings were $ 404 (95 % CI 151–636) per
patient compared to placebo, primarily because of the
difference in work absenteeism (7.83 vs. 12.9 workdays).
The incremental consequence was 0.0087 QALYs (95 %
CI 0.0052–0.0123) or 3.2 QALDs. Eight weeks after
treatment, incremental cost savings of the homeopathic
product was $ 751, with consequence gains of 0.015 QALY
123
P. Viksveen et al.
or 5.4 QALDs compared to placebo. The economic eval-
uation included costs of medication and work absenteeism.
Thompson et al. [21] published a cost-effectiveness
analysis based on a pragmatic randomised controlled trial
comparing classical homeopathy in 18 patients suffering
from severe asthma treated by a single homeopath in a
hospital outpatient department with results for 21 patients
receiving usual care in a respiratory hospital clinic over a
4-month period. No differences were found, except better
morning and afternoon peak flow in favour of usual care,
but with patients taking more and higher doses of con-
ventional medication. NHS costs were significantly higher
in the homeopathy group, primarily because of consultation
costs, with a mean difference of $ 1,129 (95 % CI
257–2,001). No significant between-group differences were
found in patient costs.
An economic evaluation by Trichard et al. [22, 23]
based on a cohort study of 268 patients suffering from ear,
nose and throat infections treated homeopathically by 73
GPs compared results to 231 patients treated convention-
ally by 62 GPs. Data collected over a 6-month period
showed that homeopathy patients had significantly fewer
episodes of rhino-pharyngitis and complications compared
to conventional treatment (p \ 0.001). Overall direct costs
were similar in the two groups, with lower costs to social
security for homeopathy patients, but higher costs to
patients (details in Table 1). Costs included consultations,
medication and tests. Differences originated from consul-
tations, and not from drugs or tests. Parents’ work absen-
teeism was reported to be lower in the homeopathy group
(13 %) than in the control group (27 %) (p = 0.001), but
resulting costs were not reported. The homeopathic
approach and direct non-health care costs were not
reported.
Studies assessing homeopaths’ treatment of patients
with eczema, diabetic neuropathy, dyspepsia, osteoarthritis
and dental surgery
The cost-effectiveness of classical homeopathy was
assessed in two 12-month uncontrolled parallel group
studies of eczema [26] and diabetic neuropathy [18] and a
6-month pragmatic randomised controlled trial in dyspep-
sia [17].
No significance between-group differences were found
by Witt et al. [26] in atopic dermatitis scores or quality of
life for 48 children with eczema treated by 10 homeopathy
physicians compared to 87 children treated by 16 con-
ventional physicians. Homeopathy patients significantly
reduced the use of conventional drugs. However, costs
were higher for the homeopathy than the conventional
group, with $ 1,335 compared to $ 734 for the first
6 months (p = 0.026) and $ 2,176 compared to $ 1,030
Economic evaluations of homeopathy
over the entire 12-month period (p = 0.001). Costs inclu-
ded consultations, medication, hospital care and work
absenteeism.
Pomposelli et al. [18] found that symptoms of diabetic
neuropathy and quality of life improved significantly in 32
patients treated homeopathically by 4 doctors in a single
clinic compared to 29 patients treated conventionally
(p = 0.016). No significant between-group differences
were found in costs of conventional drugs (details in
Table 1). No other costs were reported.
Dyspepsia symptoms improved significantly in a study
by Paterson et al. [17] at 6, 12 and 24 weeks in all three
groups (homeopathy, acupuncture and conventional treat-
ment) in a study including a total of 60 patients, with no
statistically significant between-group differences in
symptoms or costs of consultations and prescriptions.
A non-inferiority cost-minimisation analysis by Bach-
inger et al. [12] of 114 patients suffering from osteoarthritis
of the knee assessed over a 1-year period showed that costs
of injections of a homeopathic standardised combination
product were 36 % lower than injections of hyaluronic
acid. Costs per successfully treated patient were $ 2,084 in
the homeopathy group compared to $ 3,242 in the hyalu-
ronic acid group (costs of all patients divided among suc-
cessfully treated patients). Indirect costs (work disability)
and direct non-health-care costs were not reported.
A cost-effectiveness analysis published by Feldhaus [13]
reported on a single dental practice using the homeopathic
remedy Arnica montana D12 prior to and after surgical
treatment. The author found 55 % reduction in postopera-
tive treatments with insurance company costs reduced by
$ 1,267 annually and 37 % reduction in sick-leave rates
from before to after treatment. Costs were 40 % lower
compared to other dental practices in the country. The time
horizon was not reported, but consecutive patient data were
collected over a 7-year period. Data other than postopera-
tive treatment costs were not reported.
Discussion
Our literature search identified 14 studies (in 15 articles)
assessing various aspects of economic evaluations of
homeopathy. Our use of only a limited number of databases
and other sources does not rule out that additional health
economic evaluations of homeopathy exist. However, to
our knowledge, no previous reviews have reported a higher
number of studies or greater detail in reported data and
analysis of evaluations including both changes in results
and costs during and after homeopathic treatment.
Eight out of 14 identified studies reported on improve-
ments in patients’ health after homeopathic treatment
combined with some sort of cost savings. Four studies
171
found that homeopathy patients improved more than or at
least as much as patients in control groups, at comparable
costs. Only two studies found similar results when com-
paring homeopathy and control groups, but at higher costs.
Results seem promising, but limitations of existing evi-
dence reduce the reliability of results and of the possibility
to generalise to other populations.
Studies were highly heterogeneous, with considerable
variation in the applied research methodology and type of
economic evaluation, numbers and types of participants,
outcome measures, time horizon, completeness in reported
results, and statistical and economic analyses. In many
cases applied methodologies had limitations or information
on used methodologies was insufficient, reducing the reli-
ability of results, increasing the risk of bias and resulting in
difficulties in summarising results and generalising results
to other populations. The majority of studies did not
involve random selection of participants, resulting in risk
of selection bias. Lack of randomisation and limited
reporting of potential confounding factors adds to the risk
of bias. Moreover, most studies did not involve blinding of
participants, practitioners or assessors, thereby resulting in
the risk of performance bias.
Sample sizes varied considerably, ranging from 18 to
over 1,180 homeopathy patients and 21 to over 150,000
control group participants. The median number of partici-
pants was fairly low for both groups (homeopathy n = 97,
control groups n = 57). Comparability of homeopathy and
control groups was considered in the majority of the 12
studies that included control groups. Although some of
these reported baseline differences, most had comparable
groups or used adjusted analyses to control for between-
group baseline differences.
Only a few studies carried out sensitivity analyses in
order to assess the impact of variations in input parameters
on the cost-effectiveness of homeopathy. Due to limitations
in the study design, it was difficult to determine whether
improvements in patients’ symptoms and state of health
were the result of treatment, variations in their condition or
regression to the mean effects.
The time horizon varied considerably, but was at least
12 months in half of the studies. It has previously been
pointed out that the cost-effectiveness of CAM therapies
should be assessed only after a sufficiently long period of
time [6, 28, 29], with some suggesting a minimum of
6 months of treatment [30]. Results in the studies we
identified were not less promising after longer than shorter
time periods.
The majority of economic evaluations were based on
observational clinical studies (e.g. cohort study, case con-
trol study). Such economic evaluations reflect the use of
homeopathy in daily practice, but may have a limited
internal validity because of inherent weaknesses in the
123
172
clinical study design. Although a few economic evaluations
were based on randomised controlled trials, the results of
these studies are likely to suffer from a limited external
validity. There also seems to be a role for the application of
decision-analytic models to homeopathy with a view to
addressing some of the shortcomings of existing economic
evaluations. Decision-analytic models can serve to
extrapolate results over a longer time horizon, calculate
cost-effectiveness of homeopathy versus conventional
treatment instead of placebo, translate intermediate into
final outcome measures, incorporate evidence from multi-
ple clinical studies and model cost components for which
data are missing.
Recommendations
In order to reduce the risk of bias, we would primarily
recommend testing the economics of homeopathy in trials
with random allocation of participants. This would reduce
the problem of the influence of unknown confounding
factors. Some authors have pointed out that blinding of
patients and practitioners may be inappropriate or at least
involve considerable difficulties in homeopathy and other
CAM research, and alternative methodological approaches
should therefore be considered [31–33]. In our opinion,
assessors should nevertheless be blinded to reduce the risk
of bias. Another option for assessing the cost-effectiveness
of homeopathy could be large cohort studies. In such a
study participants’ characteristics should be evaluated to
determine comparability of groups. Another alternative
could be the cohort multiple randomised controlled trial
design, in which a random selection of participants are
offered the considered intervention and results are com-
pared to other cohort participants [34]. This approach has
already been used to consider the cost-effectiveness of
interventions [35–37].
Research participants should be representative of the
population and provided treatments should be representa-
tive of regular homeopathy practice in order for results to
be generalisable. This was not tested in most of the iden-
tified trials. With the exception of the rather wide category
of ‘respiratory complaints’, studies assessed either hetero-
geneous groups of patients or only single studies consid-
ered a specific diagnostic group of patients. In six of the
studies treatment was provided by a single practitioner or
clinic.
Almost all economic evaluations assessed costs of
medication, with four studies only considering medication
costs. With one exception, costs of consultations were
higher than costs of medication in the studies where this
was assessed. It is particularly important to include costs of
consultations when assessing economic evaluations of
homeopathy, as the price of homeopathic medicines is
123
P. Viksveen et al.
generally quite low compared to the cost of conventional
drugs, but the consultation usually lasts longer and costs
more. Several studies assessed work absenteeism, but not
all provided data on the results. Only a limited number of
studies considered other costs. In order to carry out a
proper economic evaluation, all of the following should be
considered: direct health-care costs (including costs of
medication, consultation fees, hospital and other care),
direct non-medical costs (e.g. for transportation), and
indirect costs such as sick-leave payment and reduced
productivity.
We agree with Hollinghurst et al. [38] who pointed out
the difficulties in valuing the complete package of benefits
offered by homeopathic treatment. It is therefore important
to identify any specific and non-specific effects of treat-
ment, patients’ preferences and subjective experiences of
treatment, and any potential side effects of treatment and to
incorporate these factors in cost-effectiveness estimates.
Future studies should preferably aim to combine mul-
tiple outcome measures into a single index that at least
accounts for quality of life. This could be done by using
quality of life measures such as EuroQol-5D (EQ-5D) [39,
40] or Short Form-6D (SF-6D) [41]. Such data can then be
used to calculate quality-adjusted life years associated with
homeopathic treatment. Moreover, the incremental cost-
effectiveness ratio should also be presented to determine
cost-effectiveness in cases where the tested intervention is
superior to the comparator, but at a higher cost. Another
approach could be the use of conjoint analysis [42]. It has
been suggested that this might be a good approach to assess
CAM therapies such as homeopathy as it takes patients’
preferences into account and it may be more helpful in
assessing benefits experienced throughout treatment, as
opposed to focusing solely on endpoint analysis [43].
Conclusion
This literature review identified 14 studies assessing eco-
nomic evaluations of homeopathy. Eight studies showed
health improvements together with cost savings and four
studies identified health improvements better or at least as
good as control groups at similar costs, whereas two studies
showed results similar to conventional treatment, but at
higher costs. However, studies were highly heterogeneous
and most had methodological limitations. It is therefore not
possible to draw any firm conclusions about the cost-
effectiveness of homeopathy based on the existing
evidence.
Acknowledgments Thanks to Riikka Sievänen and Clare Relton for
their comments on early versions of the article and Stephen Gordon
for proofreading.
Economic evaluations of homeopathy
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