Clinical effectiveness and economic evaluation of acupoint injection for the treatment of primary insomnia: a systematic review and network meta-analysis.

If you struggle to fall asleep, stay asleep, or wake feeling unrefreshed night after night, you are not alone. Primary insomnia affects millions of people worldwide and can take a serious toll on daily life, mood, and overall health. Many people are now looking beyond sleeping pills for safer, longer-lasting solutions — and a growing body of research is pointing toward traditional Chinese medicine approaches.

A new study published in the journal Cost Effectiveness and Resource Allocation took a deep dive into a lesser-known therapy called acupoint injection (AJ). This technique combines the targeted stimulation of acupuncture points with a small injection of a therapeutic substance — essentially blending the benefits of acupuncture and medicine in one treatment. Researchers conducted a systematic review and network meta-analysis, pooling data from 24 carefully selected clinical trials involving 1,851 participants to compare different AJ-related approaches for treating primary insomnia.

The results were encouraging. When acupoint injection was combined with traditional manual acupuncture — where a practitioner inserts fine needles by hand — patients showed significant improvements in sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI), a widely used clinical tool. This combination ranked among the most effective options across all the therapies studied.

Perhaps just as importantly, the researchers also looked at cost-effectiveness — something rarely examined in acupuncture research. They found that combining acupoint injection with manual acupuncture delivered meaningful sleep improvements at a relatively modest additional cost, making it a potentially practical option for many patients.

The authors do caution that the overall quality of the studies reviewed had some limitations, and they call for more high-quality research to confirm these findings. Still, for people seeking a natural, integrative approach to insomnia, this therapy shows real promise.

If you are considering acupoint injection or acupuncture for insomnia, consult a licensed and qualified acupuncture practitioner to discuss whether this approach is right for you.

This systematic review and network meta-analysis (NMA) evaluated the clinical effectiveness and cost-effectiveness of acupoint injection (AJ) for primary insomnia, drawing on 24 RCTs with 1,851 participants identified from 11 electronic databases (search date: June 10, 2025). Primary outcomes were Pittsburgh Sleep Quality Index (PSQI) scores and clinical effective rate. Risk of bias was assessed using RoB 2.0. Pairwise meta-analysis and NMA were conducted via RevMan 5.4 and R, respectively. AJ combined with manual acupuncture (MA) demonstrated statistically significant PSQI score reductions in pairwise analysis and ranked among the highest-performing interventions in the NMA. Incremental cost-effectiveness ratio (ICER) analysis indicated favorable cost-effectiveness for both PSQI improvement and responder rate outcomes. This represents the first comprehensive evidence synthesis on AJ's clinical and economic value in primary insomnia. Clinical takeaway: AJ plus MA appears to be an effective, cost-efficient adjunctive option, though findings require confirmation via high-quality, standardized RCTs.