ANTRAG Zusammenfassung und HTA-Literatur ASA Assoziation Schweizerischer Ärztegesellschaften für Akupunktur und Chinesische Medizin Sekretariat: Postfach, CH-8575 Bürglen Telefon 071 634 66 19, Telefax 071 634 66 18 E-MaiInterne Zusatzinformationen im Schlussbericht Programm Evaluation Komplementärmedizin PEK: Summary Traditional Chinese Medicine (TCM) was reimbursed by the statutory health insurance in Switzerland („Obligatorische Krankenpflegeversicherung“ (OKP)) between 2000 and 2005. A project was set up specifically to evaluate TCM, as well as other 4 systems and methods of complementary medical care from a scientifically sound perspective. The decision to stop granting these 5 systems of complementary medical care OKP reimbursement at the end of the evaluation period after 2005 was not based on scientific facts but was at least in parts politically motivated. After the referendum decision in favour of anchoring “the duty to consider complementary medical care approaches” in the constitution, a new application for automatic reimbursement is being submitted based on new data. TCM is to be applied exclusively by specially trained and certified doctors (“certificate of special ability in acupuncture and TCM”) if warranted by the indication, the resulting costs are to be reimbursed by the OKP. Any indication covering the whole spectrum of medicine may warrant TCM treatment if treatment by conventional medical practice is not absolutely necessary. This explicitly excludes diseases which have been proven to respond most efficiently to conventional treatment or where conventional medical treatment is needed to prevent damage for the patient. For many diseases, Western medicine is not able to either supply any treatment which is able to deal with the causes of the disease, or to supply any treatment which leads to a satisfactory measure of healing or improvement in the patient’s suffering. The symptomatic pharmacological treatment used by western medicine in this context is often not well tolerated by the patient or leads to side effects with complications. Many acute or chronically relapsing infections do not necessarily require an antibiotic treatment. Considering the global threat of resistance, this is even to be avoided wherever possible. Due to the different paradigm employed, TCM is often able to offer successful treatment from its perspective for many diseases. An update of the literature search shows that by now a great number of recent studies have been published concerning treatment with TCM drugs. Overall, they appear to point towards good effectiveness of TCM drug treatment compared to purely conventional treatment or to placebo. The safety of TCM drugs is guaranteed by the 4 certified companies in charge of distribution in Switzerland. These companies are in possession of a provisional SWISSMEDIC license and are responsible for ensuring that the distributed TCM drugs meet GPN-requirements, as well as conforming to legal requirements concerning pesticide, heavy metal, bacterial and other residues, as well as authenticating the contents of the individual drugs and drug preparations. Economic studies based on PEK and newer data show that treatment with TCM drugs is cheaper than conventional medical treatment provided by a general practitioner. Prior experience with the provisional reimbursement of the five complementary medical approaches by the OKP in the past shows that this leads to costs shifting from the supplementary health insurance (“Zusatzversicherung”) to the statutory health insurance. A model constructed to estimate the cost-consequences (budget impact) of readmitting TCM to reimbursement within the statutory health insurance shows a comparable development with additional pointers towards savings on the part of the health care costs paid for by patients themselves. Overall, treatment with TCM drugs may be considered an effective and low cost treatment approach given the appropriate indication which may in many cases present an addition or an alternative to conventional medical treatment. Liste der ersten identifizierten Publikationen (Reviews, Meta-Anylsen, klinische Studien) Aus: Medline, Embase, Cochranre Reviews
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(42) Endo S, Nishida T, Nishikawa K, Nakajima K, Hasegawa J, Kitagawa T et al.
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(44) Enrique E, Cistero B. Specific immunotherapy for food allergy: Basic principles and
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(45) Fei Y, Liu J. Improving the quality of reporting Chinese herbal medicine trials: An
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(46) Flower A, Liu JP, Chen S, Lewith G, Little P. Chinese herbal medicine for endometriosis.
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(47) Flower A, Liu JP, Chen S, Lewith G, Little P. Chinese herbal medicine for endometriosis -
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(55) Goto H, Satoh N, Hayashi Y, Hikiami H, Nagata Y, Obi R et al. A Chinese Herbal
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(57) Grant SJ, Bensoussan A, Chang D, Kiat H, Klupp NL, Liu JP et al. Chinese herbal
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(61) Haines CJ, Lam PM, Chung TK, Cheng KF, Leung PC. A randomized, double-blind,
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(62) Hamazaki K, Sawazaki S, Itomura M, Huan M, Shibahara N, Kawakita T et al. No effect
of a traditional Chinese medicine, Hochu-ekki-to, on antibody titer after influenza vaccination in man: A randomized, placebo- controlled, double-blind trial. Phytomedicine 2007; 14(1):11-14.
(63) He CY, Wang WJ, Li B, Xu DS, Chen WH, Ying J et al. [Clinical research of Yiqi Sanju
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(64) He Y, Lu A, Zha Y, Yan X, Song Y, Zeng S et al. Correlations between symptoms as
assessed in traditional chinese medicine (TCM) and ACR20 efficacy response: a comparison study in 396 patients with rheumatoid arthritis treated with TCM or Western medicine. J Clin Rheumatol 2007; 13(6):317-321.
(65) Hollifield M, Sinclair L, Warner T, Hammerschlag R. Acupuncture for posttraumatic stress
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(67) Hon KL, Leung TF, Ng PC, Lam MC, Kam WY, Wong KY et al. Efficacy and tolerability of
a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized, double-blind, placebo-controlled study. Br J Dermatol 2007; 157(2):357-363.
(68) Hsu C, Wang C, Hwang K, Lee T, Chou P, Chang H. The effect of auricular acupuncture
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(73) Jackson A, MacPherson H, Hahn S. Acupuncture for tinnitus: A series of six n=1
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(82) Kennedy S. Randomized controlled trial assessing a traditional Chinese medicine remedy
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(99) Lin A, Qian K, Usami Y, Lin L, Itokawa H, Hsu C et al. 5-Hydroxymethyl-2-furfural, a
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(100) Lin HS, Li DR. Phase II clinical trial for evaluating the adjuvant chemotherapy for non-
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(101) Lin L, Fu Y, Dunning T, Zhang A, Ho T, Duke M et al. Efficacy of Traditional Chinese
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(105) Liu J. The use of herbal medicines in early drug development for the treatment of HIV
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(106) Liu JP, McIntosh H, Lin H. Chinese medicinal herbs for asymptomatic carriers of hepatitis
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(108) Liu JP, Zhang M, Wang WY, Grimsgaard S. Chinese herbal medicines for type 2
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(111) Liu J. The use of herbal medicines in early drug development for the treatment of HIV
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(113) Liu TT, Shi J, Epstein DH, Bao YP, Lu L. A meta-analysis of Chinese herbal medicine in
treatment of managed withdrawal from heroin. Cell Mol Neurobiol 2009; 29(1):17-25.
(114) Liu T, Shi J, Epstein D, Bao Y, Lu L. A meta-analysis of chinese herbal medicine in
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Auswertung Daten santésuisse Datenpool, TCM-Ärzte Kennzahlen COM-Grundversorgerärzte Bezeichnung Jahr 2000 Jahr 2001 Jahr 2002 Jahr 2003 Jahr 2004 Jahr 2005 Jahr 2006 Jahr 2007 Jahr 2008
Kosten ohne Medikamente (direkt und veranlasst)
1582654867 1661526517 1754563667 1769846597 1884840938 1904595909 1885326885 1929272064 1918459529
Kosten Medikamente (direkt und veranlasst)
1654165864 1786808930 1871367812 1951907343 2103657256 2134464220 2105556233 2119556481 2135240857
Gesamtkosten (direkte und veranlasste Kosten)
3236820733 3448335451 3625931479 3721753939 3988498190 4039060126 3990883117 4048828545 4053700385
Durchschnittskosten ohne Medikamente pro Arzt
Durchschnittskosten ohne Medikamente pro Erkrankte
Durchschnittskosten Medikamente pro Erkrankten
Kennzahlen TCM-Ärzte Bezeichnung Jahr 2000 Jahr 2001 Jahr 2002 Jahr 2003 Jahr 2004 Jahr 2005 Jahr 2006 Jahr 2007 Jahr 2008
Kosten ohne Medikamente (direkt und veranlasst)
Kosten Medikamente (direkt und veranlasst)
Gesamtkosten (direkte und veranlasste Kosten)
Durchschnittskosten ohne Medikamente pro Arzt
Durchschnittskosten ohne Medikamente pro Erkrankte
Durchschnittskosten Medikamente pro Erkrankten
Indizes Vergleich TCM-Ärzte mit COM-Grundversorgerärzten Bezeichnung Jahr 2000 Jahr 2001 Jahr 2002 Jahr 2003 Jahr 2004 Jahr 2005 Jahr 2006 Jahr 2007 Jahr 2008
Durchschnittskosten ohne Medikamente pro Arzt
Durchschnittskosten ohne Medikamente pro Erkrankte
Durchnittskosten Medikamente pro Erkrankten
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Parasitol ResDOI 10.1007/s00436-008-1052-yT. J. Naucke & B. Menn & D. Massberg & S. LorentzReceived: 10 April 2008 / Accepted: 26 May 2008Abstract This study has provided evidence for the naturalbeen 11 cases of leishmaniasis in Germany in which anoccurrence of sandflies in Germany. Two species belonging toautochthonous origin was confirmed or which were highlythe genus Phleboto