Abstract | BACKGROUND: The PACE trial compared the effectiveness of adding adaptive pacing therapy ( APT), cognitive behaviour therapy (CBT), or graded exercise therapy (GET), to specialist medical care (SMC) for patients with chronic fatigue syndrome. This paper reports the relative cost-effectiveness of these treatments in terms of quality adjusted life years (QALYs) and improvements in fatigue and physical function. METHODS: Resource use was measured and costs calculated. Healthcare and societal costs (healthcare plus lost production and unpaid informal care) were combined with QALYs gained, and changes in fatigue and disability; incremental cost-effectiveness ratios (ICERs) were computed. RESULTS: SMC patients had significantly lower healthcare costs than those receiving APT, CBT and GET. If society is willing to value a QALY at £30,000 there is a 62.7% likelihood that CBT is the most cost-effective therapy, a 26.8% likelihood that GET is most cost effective, 2.6% that APT is most cost-effective and 7.9% that SMC alone is most cost-effective. Compared to SMC alone, the incremental healthcare cost per QALY was £18,374 for CBT, £23,615 for GET and £55,235 for APT. From a societal perspective CBT has a 59.5% likelihood of being the most cost-effective, GET 34.8%, APT 0.2% and SMC alone 5.5%. CBT and GET dominated SMC, while APT had a cost per QALY of £127,047. ICERs using reductions in fatigue and disability as outcomes largely mirrored these findings. CONCLUSIONS: Comparing the four treatments using a health care perspective, CBT had the greatest probability of being the most cost-effective followed by GET. APT had a lower probability of being the most cost-effective option than SMC alone. The relative cost-effectiveness was even greater from a societal perspective as additional cost savings due to reduced need for informal care were likely.
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Authors | Paul McCrone, Michael Sharpe, Trudie Chalder, Martin Knapp, Anthony L Johnson, Kimberley A Goldsmith, Peter D White |
Journal | PloS one
(PLoS One)
Vol. 7
Issue 8
Pg. e40808
( 2012)
ISSN: 1932-6203 [Electronic] United States |
PMID | 22870204
(Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Topics |
- Adult
- Cognitive Behavioral Therapy
(economics, methods)
- Costs and Cost Analysis
- Exercise Therapy
(economics, methods)
- Fatigue Syndrome, Chronic
(economics, therapy)
- Female
- Humans
- Male
- Middle Aged
- United Kingdom
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