Chinese Herbal Medicine Treatment for Alzheimer’s Disease Inpatients in China: Alternative or Complement to Conventional Medicine, a Cross-sectional Study

Objectives Chinese herbal medicine (CHM), a typical type of complementary and alternative medicine (CAM), has been used to treat Alzheimer’s disease (AD) with costs covered by China’s urban basic medical insurance. Previous studies have demonstrated the treatment effectiveness of CHM for intractable disease and CHM’s ability to reduce medical costs. There has been no research exploring the impact of CHM on AD inpatient hospital costs or whether CHM is a complement or alternative to conventional medicine treatments. We compared the medical costs of AD inpatients, CHM users, and non-CHM users to analyze whether CHM has increased or decreased the AD inpatient costs, to assess whether CHM was an alternative or complementary treatment. Methods Our cross-sectional research was based on a 5% random sample from the 2010 to 2016 Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI) claim data, yielding information on 1507 urban AD inpatients. Wilcoxon rank sum test and chi square test were applied to the medical cost data with an abnormal distribution. To control for confounding factors, such as demographic (age and sex) and medical costs, the influence between CHM costs and conventional medicine costs were analyzed by quantile regression. Results CHM users accounted for 79.83% (1203/1507) of the total inpatients. The median inpatient cost of CHM users was RMB13293.95 (USD2084.49), which was higher than non-CHM users’ (RMB8428.10/USD1321.53, P<0.001). The median CHM cost was RMB721.00 (USD113.05). Positive correlations between CHM users and CHM costs were found after controlling for confounder variables (Coef.=0.09, P<0.001). Conclusion During 2010-2016, nearly 80% of AD inpatients in our sample used CHM. Participation in CHM increased the total inpatient costs, pharmacy costs, and conventional medicine costs of AD inpatients over non-CHM users. CHM mainly plays a complementary or less alternative role to conventional medicine for AD treatment. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement YES - the Research on the implementation strategy of traditional Chinese medicine disease classification and payment [grant number: 90020671720021] ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine (no.2019BZHYLL0201) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data that support the findings of this study are available from China Health Insurance Research Association, but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available. Data are however available from Xuefeng Shi upon reasonable request and with permission of the China Health Insurance Research Association. If someone wants to request the data from this study, please contact the China Health Insurance Research Association.