Jaseng Hospital of Korean Medicine Proves Effectiveness and Cost-Effectiveness of Pharmacopuncture for Frozen Shoulder

Pharmacopuncture therapy, which injects the active ingredients of herbal medicine into the area of pain, has been shown to be not only more effective than physical therapy for patients with adhesive capsulitis, but also more cost-effective.

The research team led by Director Doori Kim of the Spine and Joint Research Institute at Jaseng Hospital of Korean Medicine announced on April 28 that their findings were published in the SCI(E)-level international academic journal "Healthcare" (Impact Factor 2.7), through a joint study with Dr. Changhyun Han's team at the Korea Institute of Oriental Medicine.

Kim Doori, Director of the Spine and Joint Research Institute at Jaseng Hospital of Korean Medicine. Jaseng Hospital of Korean Medicine

Adhesive capsulitis is a condition in which inflammation and fibrosis occur in the shoulder joint capsule, causing it to thicken and adhere, resulting in restricted movement. It commonly appears after the age of 50 and is also known as "frozen shoulder," with a high incidence in older adults. According to the Health Insurance Review and Assessment Service, as of 2024, about 800,000 patients visited hospitals for adhesive capsulitis, and approximately 80% of all patients were aged 50 or older. Major symptoms include shoulder pain, stiffness, and restricted movement. Initially, pain is the predominant symptom, but over time, the range of motion in the joint gradually decreases. As a result, it becomes difficult to rotate the arm inward or outward, and even daily activities such as washing hair or getting dressed may be limited.

For adhesive capsulitis, conservative treatments such as injection therapy, drug therapy, and physical therapy are prioritized. Some patients, seeking better efficacy and safety, opt for integrative Korean medicine treatments, including acupuncture, pharmacopuncture, and Chuna manual therapy.

However, until now, there have been no studies evaluating the cost-effectiveness of pharmacopuncture for adhesive capsulitis. Director Kim's research team previously conducted a pilot clinical study comparing the efficacy and safety of pharmacopuncture and physical therapy for adhesive capsulitis, and based on those results, evaluated the cost-effectiveness of pharmacopuncture.

In the pilot clinical study, 50 patients aged 19 to 69 who had suffered from shoulder pain for more than one month and reported a pain score of 5 or higher on the Numeric Rating Scale (NRS; 0-10) were randomly assigned to either the pharmacopuncture group or the physical therapy group. Both groups received treatment twice a week for six weeks. As a result, the pharmacopuncture group saw a 2.2-point greater reduction in NRS scores and a 21.5-point greater improvement in the Shoulder Pain and Disability Index (SPADI; 0-100) compared to the physical therapy group. Additionally, in tests measuring the range of motion (ROM) of the shoulder, the pharmacopuncture group showed an approximately 27-degree greater increase in shoulder abduction angle compared to the physical therapy group.

This paper also evaluated the cost-effectiveness of pharmacopuncture based on data collected from the above clinical study. To assess cost-effectiveness, the Quality Adjusted Life Year (QALY) was calculated. QALY is an index that quantifies the duration of healthy life and is commonly used in economic evaluations. A score of 1 represents perfect health, while 0 represents "death" or a state worse than death; the higher the value, the better the health status over one year without disease or disability.

The calculation of QALY utilized the EuroQol-5 Dimension (EQ-5D; 0-1) and the Short Form-6 Dimension (SF-6D; 0-1) quality of life scales. The analysis showed that, compared to the physical therapy group, the pharmacopuncture group had a QALY increment of 0.014 using EQ-5D and 0.013 using SF-6D.

Costs were calculated both from a societal perspective—including medical costs and productivity loss—and from a healthcare system perspective, which considers only medical costs. From the societal perspective, the total cost for the pharmacopuncture group was $2,235, which was approximately $1,524 (about 1.93 million won) less than the $3,759 for the physical therapy group. Therefore, pharmacopuncture was found to be a dominant treatment, providing higher QALY at a lower cost compared to physical therapy.

From the healthcare system perspective, the pharmacopuncture group incurred approximately $62 (about 80,000 won) more than the physical therapy group. The Incremental Cost-Effectiveness Ratio (ICER), which represents the additional cost required to gain one more QALY, was also calculated. The ICER for pharmacopuncture, compared to physical therapy, was $4,386 (about 648,000 won) using EQ-5D and $4,790 (about 708,000 won) using SF-6D. These figures are significantly lower than the widely accepted willingness-to-pay (WTP) threshold of $26,375 per QALY. Furthermore, a probabilistic sensitivity analysis indicated that, based on the WTP threshold, the probability of pharmacopuncture being cost-effective compared to physical therapy exceeded 97%.

Director Doori Kim of the Spine and Joint Research Institute at Jaseng Hospital of Korean Medicine stated, "This study confirmed that pharmacopuncture is an effective and economical treatment option for patients with adhesive capsulitis. However, since this was a pilot study involving only 50 participants, we aim to enhance the reliability of these results through larger-scale follow-up studies and provide patients with evidence-based alternatives for treatment selection."

This content was produced with the assistance of AI translation services.