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CBT and GET did not significantly reduce employment losses, overall service costs, welfare benefits or other financial payments

Posted by biophile on 08 Aug 2012 at 04:20 GMT

McCrone et al (2012) have published the much-awaited results of the PACE Trial concerning cost-effectiveness, service costs, employment losses, and welfare benefits or other financial payments. Taking center stage was the main conclusion that compared to SMC alone, adjunctive CBT, and to a lesser extent, GET were hypothetically more cost-effective. This was based on cost-effectiveness acceptability curves and calculations derived from self-reports involving quality of life, fatigue, and physical function. Adjunctive APT was not found to be cost-effective. [1]

The MRC press release [2] and other news article headlines [3][4] give optimistic coverage about the (hypothetical) cost-effectiveness of CBT and GET, suggesting that these therapies should become widely available and will even save the economy millions of pounds. [5] However, there has been a glaring omission in this coverage, one which was also relegated to lesser importance in the paper itself. That is, CBT and GET do very little if anything at all to reduce employment losses, overall service costs, and welfare benefits or other financial payments. [1]

Raw values given in Table 3 suggest an 8.0% reduction in total service costs for the SMC group at follow-up and a 10.5% reduction for the CBT group. When controlling for baseline, the authors indicate that there were no statistically significant difference between these two groups, or any groups except CBT vs APT.Furthermore, despite self-reported improvements in QOL, fatigue and physical function, Table 4 shows that welfare benefits or other financial payments actually increased for all groups during the course of the trial. The authors describe the overall increases as slight and concede that there were no statistically significant differences between groups at follow-up, but failed to account for this category of costs during their cost analyses and provide no reason. Such poor outcomes should be a rather sobering revelation for the Department of Work and Pensions (which helped to fund the trial) and for the insurance industry, both which some of the authors have declared working for as consultants. [6]

The improvement in quality of life after therapy appears to be minimal. After controlling for baseline, there were no statistically significant differences between any groups at follow-up except for CBT vs SMC (+0.05 QALY). CBT and GET were "cost-effective" because they are relatively cheap therapies compared to the usual service costs incurred by CFS patients, and result in hypothetical savings in terms of self-reported QOL, fatigue, and physical function. CBT and GET do little if anything to reduce overall service costs and therefore will not save the UK government money, so it is time they look towards alternative approaches such as biomedical research. Is it any surprise that only one week before publication of McCrone et al 2012, that the MRC in the UK announced additional funding in that direction? [7]

[1] McCrone P, Sharpe M, Chalder T, Knapp M, Johnson AL, et al. (2012) Adaptive Pacing, Cognitive Behaviour Therapy, Graded Exercise, and Specialist Medical Care for Chronic Fatigue Syndrome: A Cost-Effectiveness Analysis. PLoS ONE 7(8): e40808. doi:10.1371/journal.pone.0040808

[2] Two effective treatments for CFS/ME are also cost-effective | 1 August 2012 |

[3] Chronic fatigue syndrome: Brain training is most cost-effective treatment. | 2 August 2012 Last updated at 01:57 GMT |

[4] Two chronic fatigue syndrome treatments offer good value | John von Radowitz | Thursday 02 August 2012 |

[5] Pacing 'not cost-effective’ for CFS | Thursday August 2 2012 |

[6] White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, Baber HL, Burgess M, Clark LV, Cox DL, Bavinton J, Angus BJ, Murphy G, Murphy M, O'Dowd H, Wilks D, McCrone P, Chalder T, Sharpe M; [PACE trial management group]. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011 Mar 5;377(9768):823-36. Epub 2011 Feb 18. DOI: 10.1016/S0140-6736(11)60096-2 http://www.ncbi.nlm.nih.g...

[7] New ME/CFS highlight notice issued by the UK Medical Research Council. | 23 July 2012 | http://www.meassociation....

Competing interests declared: A long-term ME/CFS patient.