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To assess quality of life (QoL), costs, and cost-effectiveness of acupuncture treatment plus routine care versus routine care alone in osteoarthritis patients, a randomised, controlled trial was conducted in 255 general practices in Germany. Four hundred and eighty-nine patients with chronic pain due to osteoarthritis of the knee or hip were included to evaluated QoL and costs at baseline and after 3 months using health insurance funds data and standardized questionnaires. Patients receiving acupuncture had an improved QoL associated with significantly higher costs over the 3 months treatment period compared to routine care alone (mean cost-difference: €469.50 [95%CI €135.80–€803.19]). This increase in costs was primarily due to the costs of acupuncture. The overall ICER was €17,845 per QALY gained. The degree of cost-effectiveness was influenced by gender, with female patients achieving a …