Dutch Research on the Cost-Effectiveness of CAM (2006–2009)

From 2006 to 2011 a study on the relationship between CAM and the cost of healthcare was carried out in the Netherlands by Peter Kooreman and Erik Baars. Kooreman is a professor at the Department of Economics at Tilburg University, the Netherlands. He specializes mainly in health care economics. Baars is a medical doctor and epidemiologist. He works as a researcher and professor of Anthroposophic Healthcare at the University of Applied Sciences in Leiden, the Netherlands. (31)
The aim of the study was to compare the results of work carried out by CAM-certified general practitioners and general practitioners without this certification. The CAM therapies included in the study were anthroposophic medicine, homeopathy and acupuncture. The research was based on data provided by the insurance company Azivo, which operates mainly in the Haag. The data was documented between 2006 and 2009.
The results were published in 2011 in the study “Patients whose GP knows complementary medicine tend to have lower costs and live longer” (32). The authors won the Award of Excellence in Integrative Medicine Research from the European Society of Integrative Medicine (in the category “clinical research”). We cite the abstract of this study:


Health economists have largely ignored complementary and alternative medicine (CAM) as an area of research, although both clinical experiences and several empirical studies suggest cost-effectiveness of CAM.

To explore the cost-effectiveness of CAM compared with conventional medicine.

A dataset from a Dutch health insurer was used containing quarterly information on healthcare costs (care by general practitioner (GP), hospital care, pharmaceutical care, and paramedic care33), dates of birth and death, gender and 6-digit postcode of all approximately 150,000 insurees, for the years 2006-2009. Data from 1913 conventional GPs were compared with data from 79 GPs with additional CAM training in acupuncture (25), homeopathy (28), and anthroposophic medicine (26).

Patients whose GP has additional CAM training have 0 - 30% lower healthcare costs and mortality rates, depending on age groups and type of CAM. The lower costs result from fewer hospital stays and fewer prescription drugs.

Since the differences are obtained while controlling for confounders including neighborhood specific fixed effects at a highly detailed level, the lower costs and longer lives are unlikely to be related to differences in socioeconomic status. Possible explanations include selection (e.g. people with a low taste for medical interventions might be more likely to choose CAM) and better practices (e.g. less overtreatment, more focus on preventive and curative health promotion) by GPs with knowledge of complementary medicine. More controlled studies (replication studies, research based on more comprehensive data, cost-effectiveness studies on CAM for specific diagnostic categories) are indicated.”

The same authors, professor Peter Kooreman and Dr. Erik Baars, published a more detailed report in 2014 based on the same research from 2006–2011. A 6-year comparative economic evaluation of healthcare costs and mortality rates of Dutch patients from conventional and CAM GPs (34). The summary of this report was published on the EUROCAM website in 2016. A quote from the summary follow below:

“Dutch patients whose GP additionally completed training in CAM on average have €192 (10.1%) lower annual total compulsory and supplementary healthcare costs and do not live longer or shorter than patients with a conventional GP.
This is the conclusion of a Dutch study that calculated the healthcare costs and mortality rates of 1,521,773 patients (98.8%) with a conventional (CON) general practitioner (GP) and compared them with data of 18,862 patients (1.2%) with a GP who has additionally completed training in complementary and alternative medicine (CAM).” (35)