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Randomized Controlled Trial
. 2013 Jan 18:14:12.
doi: 10.1186/1471-2296-14-12.

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

Gerry Richardson  1 , David Epstein, Carolyn Chew-Graham, Christopher Dowrick, Richard P Bentall, Richard K Morriss, Sarah Peters, Lisa Riste, Karina Lovell, Graham Dunn, Alison J Wearden; FINE Trial Writing group on behalf of the FINE Trial group
Collaborators, Affiliations
Randomized Controlled Trial

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

Gerry Richardson et al. BMC Fam Pract. .

Abstract

Background: 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 trial. 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.

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Figures

Figure 1
Figure 1
Mean costs per patient accrued during the trial by treatment (n=254).
Figure 2
Figure 2
Changes in EQ5D index over time by treatment group.
Figure 3
Figure 3
Cost-effectiveness acceptability curve.
See this image and copyright information in PMC

References

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