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

BMC Family Practice

Research Article

David Epstein¹  Gerry Richardson¹  Graham Dunn²  Carolyn Chew-Graham²  Richard K Morriss³  Karina Lovell⁴  Christopher Dowrick⁵  Lisa Riste⁶  Alison J Wearden⁶  Sarah Peters⁶  Richard P Bentall⁷ 

[1] Centre for Health Economics, University of York, Hull/York Medical School, YO10 5DD, York, United Kingdom;School of Community Based Medicine, University of Manchester, M13 9PL, Manchester, United Kingdom;School of Community Health Sciences, Institute of Mental Health, University of Nottingham, NG7 2TU, Nottingham, United Kingdom;School of Nursing, Midwifery and Social Work, University of Manchester, M13 9PL, Manchester, United Kingdom;School of Population, Community and Behavioural Sciences, University of Liverpool, L69 3GB, Liverpool, United Kingdom;School of Psychological Sciences, University of Manchester, M13 9PL, Manchester, United Kingdom;School of Psychology, University of Bangor, Adeilad Brigantia, Penrallt Road, LL57 2AS, Bangor, Gwynedd, United Kingdom;

关键词: Cost-effectiveness;    Primary care;    CFS/ME;    Self-management;    Supportive listening;    Pragmatic rehabilitation;   

DOI  :  10.1186/1471-2296-14-12

 received in 2012-08-16, accepted in 2013-01-07,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundNurse 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.MethodsCost-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.ResultsTreatment 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.ConclusionsThis 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 registrationThe trial registration number is IRCTN74156610

【 授权许可】

Unknown   
© Richardson et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.