In another German study, the clinical effectiveness and cost-effectiveness of acupuncture in patients with dysmenorrhoea was studied. In a randomised controlled trial plus non-randomised cohort, patients with dysmenorrhoea were randomised to 15 sessions of acupuncture over three months or to a control group (no acupuncture). All subjects were allowed to receive usual medical care. Of 649 women, 201 were randomised. Those who declined randomisation received acupuncture treatment. After three months, the average pain intensity was lower with acupuncture than without (3.1 vs. 5.4). The authors concluded that additional acupuncture in patients with dysmenorrhoea was associated with improvements in pain and quality of life as compared to usual care alone and was cost-effective within usual thresholds (overall ICER 3,011 euros per QALY). (Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008 Feb;198(2):166.e1-8).