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Are treatments that only works for 1/3 of patients truly cost effective

Posted by kelly1 on 02 Aug 2012 at 00:12 GMT

This was a large expensive trial for rather modest results that can only be narrowly extrapolated.

A read of the full original study reveals that only one out of three patients improved with either CBT or graded exercise. This means that the majority of people did not improve, despite all the time, money and effort. Treatments that may not be effective for 2/3 of patients are not cost effective.

As well, the authors used a uncommon and rarely used definition from 1991 paid for in part by one of the authors (Sharpe et al 1991). Studying peaches, calling them apples and extrapolating the results to all "fruit" is poorly done science and does not meet the gold standard of evidence-based medicine.

The gold standard for making comparisons across groups of patients identified by three varying case definitions (which have been proven to select very different patient groups - Fukuda et al 1994, Carruthers et al 2003, 2011) would be a study with three completely separate cohorts, not one large sample with embedded subgroups.

No competing interests declared.

RE: Are treatments that only works for 1/3 of patients truly cost effective

ZigZag replied to kelly1 on 03 Aug 2012 at 00:14 GMT

In the PACE Trial, CBT failed to meet the threshold for a clinical useful outcome (clinically useful difference from SMC) for physical disability, and was found to be 'moderately effective' only for fatigue.

In terms of the proportion of participants who achieved a clinically useful outcome (clinically useful difference from SMC), the results were as follows:

CBT physical function 13% (NNT = 1 in 8)
CBT fatigue 11% (NNT = 1 in 9)

GET physical function 12% (NNT = 8)
GET fatigue 15% (NNT = 7)

By contrast, 58% (physical function) and 65% (fatigue) of the SMC group achieved a clinically useful outcome.

No competing interests declared.