Acupuncture for Menopause Depression: Korean Cohort Found No QALY Gain

A 2026 Korean claims analysis of 32,941 women with menopausal disorders found that traditional Korean medicine without recorded acupuncture claims had the lowest 3-year cost and the highest mean quality-adjusted life-year estimate, while acupuncture-inclusive or Western-medicine-inclusive strategies cost more and produced slightly lower QALYs.

Quality-adjusted life years (QALYs) combine survival and quality of life into one health-economic unit. A treatment that costs more and produces fewer QALYs is usually called dominated, meaning the comparison gives no economic reason to prefer it.

Lee et al. tested 4 claims-defined menopause care strategies in Korea: TKM without acupuncture claims, TKM plus acupuncture, TKM plus Western medicine, and TKM plus Western medicine plus acupuncture. Depression incidence and menopause-related medical costs were tracked over a 3-year horizon.

TKM Without Acupuncture Claims Had the Best Cost-Utility Profile

The main result was unusually blunt for a real-world integrative-care study. TKM without recorded acupuncture claims was the reference strategy and had the lowest cost, KRW 62,267, with the highest mean QALY estimate, 2.11.

Every comparator moved in the wrong economic direction:

• TKM plus acupuncture: KRW 147,087, 2.08 QALYs, delta cost KRW 84,820, delta QALY −0.0222.
• TKM plus Western medicine: KRW 162,734, 2.10 QALYs, delta cost KRW 100,467, delta QALY −0.0101.
• TKM plus Western medicine plus acupuncture: KRW 248,174, 2.03 QALYs, delta cost KRW 185,907, delta QALY −0.0718.

Incremental cost-effectiveness ratio (ICER) normally asks how much extra cost buys 1 extra QALY. Here, the ICER calculation mostly collapsed into dominance logic because the add-on strategies cost more and produced slightly fewer QALYs.

The willingness-to-pay threshold in the analysis was KRW 30,000,000 per QALY. That threshold did not rescue the add-on strategies because they did not buy extra modeled health benefit in the first place.

Threshold logic: willingness-to-pay thresholds only help when an added service produces more health. If a pathway costs more and produces fewer modeled QALYs, the problem is not that the threshold is too strict. The problem is that the comparison is economically dominated before the threshold question even starts.

Higher-Cost Care Probably Marked More Severe Menopause Cases

The clean economic ranking can be misread. The strongest clinical interpretation is not “acupuncture worsened menopause depression.” The better reading is severity selection: women who received acupuncture, Western medicine, or both appeared to have more complicated illness and heavier utilization.

Episode duration exposed the imbalance: the TKM plus Western medicine plus acupuncture group had a mean menopausal disorder episode duration of 966.38 days. The TKM reference group had 17.39 days. Visit counts moved the same way, with 19.49 visits in the full integrative group vs. 1.47 visits in the reference group.

Baseline clinical burden also differed. Sleep disorder claims appeared in 17.3% of the full integrative group vs. 7.6% of the TKM reference group. Musculoskeletal symptoms were common in every group, but reached 84.2% in the full integrative group.

The researchers used inverse probability of treatment weighting (IPTW), a statistical method that reweights observational groups to make measured baseline variables more comparable. IPTW can reduce measured imbalance, but it cannot eliminate hidden symptom severity that never appears cleanly in claims data.

Why the duration gap matters: a 966.38-day mean episode marks more than a longer billing trail. It probably identifies patients whose symptoms kept returning, overlapped with pain or sleep problems, or failed to settle after low-intensity care. That makes the add-on groups clinically different before any treatment effect is estimated, especially in a claims design without direct symptom scales.

Clinical Acupuncture Evidence Does Not Equal Incremental Cost-Utility

Adjacent evidence makes the 2026 result more useful and less simplistic. Zhao et al. reviewed acupuncture as independent or adjunctive management for perimenopausal depression and reported supportive clinical evidence. Befus et al. reviewed acupuncture for menopause symptoms more broadly, including vasomotor symptoms.

Those papers answer a clinical-effect question: can acupuncture reduce symptoms in some menopausal or perimenopausal patients? Lee et al. asked a narrower economic question: when women are already inside a TKM claims pathway, does adding acupuncture or Western medicine produce enough additional claims-modeled benefit to justify the extra cost?

That distinction also explains why the Korean result differs from the ACUDep economic analysis. Spackman et al. reported that acupuncture for depression cost around GBP 4,560 per QALY compared with usual care. The Korean cohort did not compare acupuncture with usual care alone. It compared acupuncture-inclusive TKM with active TKM care without recorded acupuncture claims.

Comparator choice: acupuncture can look useful when the alternative is minimal or usual care, yet look economically weak when added to an already active care package. Both findings can be true.

Claims Data Miss Patient-Reported Symptom Relief

Evidence-strength note: this was a retrospective claims analysis, not a randomized trial. It supports a cautious reimbursement and triage argument, not a patient-level ban on acupuncture for menopausal symptoms.

The QALY estimates came from literature-based utility values rather than direct EQ-5D, MENQOL, or daily symptom ratings. That matters because menopause care often targets hot flashes, sleep disruption, anxiety, irritability, pain, and perceived control — outcomes that may not map cleanly onto administrative claims.

Hooper et al. reported that worse recalled menopause symptom severity was tied to worse mental health and quality of life in postmenopausal women. If the women who escalated to integrative care were already more symptomatic, lower modeled QALYs may partly reflect the reason they received more care, not the effect of the care itself.

Several limits keep the finding calibrated:

• No Western-medicine-only group: the study could not tell whether conventional care alone would have been cheaper or more effective.
• Claims-defined acupuncture exposure: recorded acupuncture claims may not capture treatment quality, dose, adherence, or out-of-pocket care.
• Residual confounding: IPTW balanced measured variables, but not every dimension of symptom burden, preference, or prior treatment failure.
• Small QALY gaps: the absolute QALY differences were modest, so the economic result should not be treated as a large clinical-effect estimate.

Practical Read for Menopause Depression Care

The most defensible policy read is stepped care. In a Korean reimbursement context, conservative TKM care without recorded acupuncture claims looked economically favorable as an initial pathway. More intensive integrative care may still make sense for women with longer, more complex, more refractory symptoms.

For individual patients, the result argues against automatic escalation. If acupuncture is added for menopausal depression, sleep disruption, vasomotor symptoms, or pain, the rationale should be explicit: which symptom is being targeted, what improvement would count, and when the add-on should stop if nothing changes.

Clinical implication: acupuncture is not disproven by this claims study, but the burden of proof shifts to patient-centered response. The add-on should earn its place with measurable symptom relief, not with a blanket assumption that integrative care is automatically higher value.

For reimbursement decisions, the cleaner standard is conditional use. Acupuncture can remain available for women who value it or report meaningful symptom relief, while routine escalation after a menopause diagnosis should require a stated target such as sleep, hot flashes, pain, depressive symptoms, or medication avoidance.

Questions About Acupuncture, Menopause, and Depression Cost-Utility

Did the Korean study show acupuncture is ineffective for menopause depression?

No. It showed that acupuncture-inclusive claims groups cost more and had slightly lower modeled QALYs than TKM without acupuncture claims. That is an economic and observational result, not a randomized clinical-efficacy verdict.

Why would acupuncture users have worse QALY estimates?

The most plausible explanation is confounding by indication. Patients with more severe symptoms, longer care episodes, or more comorbid problems are more likely to receive add-on care, and those baseline differences can pull QALY estimates downward.

What would settle the question better?

A prospective trial should compare staged menopause depression care pathways, measure depression, sleep, vasomotor symptoms, pain, and quality of life directly, and stratify patients by baseline severity before estimating cost per QALY.

Bottom Line

Lee et al. found that acupuncture-inclusive and integrative care pathways for menopausal disorders were more expensive without modeled QALY gains in Korean claims data. The result is strongest as a warning against automatic add-on care, not as proof that acupuncture cannot help selected women with menopausal depression or related symptoms.

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