Friday, January 18, 2013

Cost-effectiveness of rehab

Note: According to the authors, "PR provides an explanation for patients'
symptoms, based on a model in which CFS occurs as a consequence of
physiological dysregulation associated with inactivity, disturbance of
sleep and circadian rhythms
, and the somatic symptoms of arousal or

The explanation provides the rationale for a rehabilitation program,
developed collaboratively with the patient, which includes a graded return
to activity and normalisation of sleep patterns."

Other researchers have found the physiological deregulation precedes
lessened activity.

BMC Family Practice 2013, 14:12

Cost-effectiveness of supported self-management for CFS/ME patients in
primary care

Gerry Richardson, David Epstein, Carolyn Chew-Graham, Christopher Dowrick,
Richard P Bentall, Richard K Morriss, Sarah Peters, Lisa Riste, Karina
Lovell, Graham Dunn , Alison J Wearden

Nurse led self-help treatments for people with chronic fatigue
syndrome/myalgic encephalitis (CFS/ME) have been shown to be effective in
reducing fatigue but their cost-effectiveness is unknown.

Methods: Cost-effectiveness analysis conducted alongside a single blind
randomised controlled trial comparing pragmatic rehabilitation (PR) and
supportive listening (SL) delivered by primary care nurses, and treatment
as usual (TAU) delivered by the general practitioner (GP) in North West
England. A within trial analysis was conducted comparing the costs and
quality adjusted life years (QALYs) measured within the time frame of the

296 patients aged 18 and over with CFS/ME diagnosed using the Oxford
criteria were included in the cost-effectiveness analysis.

Results: Treatment as usual is less expensive and leads to better patient
outcomes compared with Supportive Listening. Treatment as usual is also
less expensive than Pragmatic Rehabilitation.

PR was effective at reducing fatigue in the short term, but the impact of
the intervention on QALYs was uncertain. However, based on the results of
this trial, PR is unlikely to be cost-effective in this patient population.

Conclusions: This analysis does not support the introduction of SL

Any benefits generated by PR are unlikely to be of sufficient magnitude to warrant recommending PR for this patient group on cost-effectiveness grounds alone. However, dissatisfaction with current treatment options
means simply continuing with 'treatment as usual' in primary care is
unlikely to be acceptable to patients and practitioners.

Trial registration: The trial registration number is IRCTN74156610

No comments: