Cost-Utility Analysis of Traditional Korean Medicine Alone Versus Combined Korean and Western Medicine for Depression in Patients with Menopausal Disorders: A Retrospective Cohort Study Using National Health Insurance Claims Data

Objectives: This study aimed to compare the cost-utility of traditional Korean medicine (TKM) alone versus combined TKM and Western medicine (TKM+WM) as treatment strategies for the prevention of depression in women with menopausal disorders. We utilized nationwide real-world claims data provided by the Health Insurance Review and Assessment Service (HIRA) of South Korea.Methods: A retrospective cohort study was conducted using customized national health insurance claims data from the Health Insurance Review and Assessment Service (HIRA) between 2015 and 2023. Women diagnosed with menopausal disorders (KCD code N95) at Korean medicine institutions were identified and followed for three years from the index date. Based on treatment patterns during the episode period, participants were classified into a traditional Korean medicine (TKM) only group and a TKM plus Western medicine (TKM+WM) group. The incidence of depression was defined using ICD-10 codes F32–F33. Quality-adjusted life years (QALYs) were estimated using utility weights of 0.85 (without depression) and 0.65 (with depression), and incremental cost-effectiveness ratios (ICERs) were calculated. Sensitivity analyses were performed to assess the impact of changes in utility values and discount rates.Results: The TKM+WM group had higher medical costs (160,817 KRW vs. 73,862 KRW) and achieved higher QALYs (2.37 vs. 2.18) compared to the TKM-only group. The resulting incremental cost-effectiveness ratio (ICER) was estimated at 445,657 KRW per QALY gained, which is substantially below the widely accepted willingness-to-pay (WTP) threshold in South Korea (30 million KRW/QALY). Sensitivity analyses confirmed the robustness of these findings across varying assumption.Conclusions: Based on real-world claims data analysis, combined Korean and Western medicine treatment showed favorable cost-effectiveness compared to Korean medicine alone for managing menopausal women at risk of depression in the Korean healthcare context. However, these observational findings should be interpreted with caution regarding causal inference. Further prospective studies are needed to confirm these associations and inform evidence-based policy decisions regarding integrative care and reimbursement strategies.