Medicines containing valerian to treat insomnia, mental stress and test anxiety
Medicines containing valerian are a popular herbal remedy for promoting sleep and relieving mental stress and test anxiety. The treatment costs covered by the mandatory health insurance have tripled since 2014. This HTA report therefore examines the clinical effectiveness, safety, and economic impact of medicines containing valerian compared to a placebo or other treatments, as well as the associated ethical, legal, social and organisational issues. The results are intended to provide a basis on which to decide whether these medicines will continue to be reimbursed by the mandatory health insurance.
A systematic literature review was carried out, comprising 26 studies on individual valerian therapy and seven studies involving therapy combining valerian with lemon balm or hops for people with insomnia. Most of the results showed no improvement compared with a placebo or other treatments. Only sleep quality showed a marked improvement. Four other studies looked at a combination therapy using valerian with lemon balm or hops to treat mental stress and two studies focused on test anxiety or anxiety (with combination therapies involving valerian, lemon balm, passion flower and butterbur). These studies provided too little data to draw any conclusions on effectiveness. For the assessment of safety, the analyses of the studies examined provided only very limited evidence.
Modelling over a five-year period showed a significant budget impact in the three treatment areas: no longer reimbursing medicines containing valerian would result in savings of CHF 202 million (including medication costs, healthcare provider consultation costs, and dependence-related healthcare costs associated with substitute treatments). Of this, CHF 174 million relates to insomnia, CHF 22 million to test anxiety and CHF 6 million to mental stress.
The assessment of ethical, legal, social and organisational issues revealed that withdrawing reimbursement is legally justified due to a lack of effectiveness. From a social perspective, however, this could lead to financial barriers for vulnerable population groups, making transitional support measures necessary. From an organisational perspective, this could mean increased demand and longer consultation times in mental health services.
The report concludes that most studies do not show any proven effectiveness for valerian treatments. Valerian only performs better than a placebo in terms of sleep quality. For mental stress and test anxiety or anxiety, there was not enough information available. More than CHF 200 million could be saved within five years if medicines containing valerian are no longer reimbursed. As a result of a lack of effectiveness, discontinuing reimbursement is justified; only access for vulnerable populations would have to be ensured.
Federal Office of Public Health FOPH
Health Technology Assessment Section
Schwarzenburgstrasse 157
Switzerland - 3003 Bern