Cost-effectiveness of an extended-role [GP] clinic for [PPS]: results from the Multiple Symptoms Study 3 (MSS3)... 2024 Deary, Burton et al

Full title: Cost-effectiveness of an extended-role general practitioner clinic for persistent physical symptoms: results from the Multiple Symptoms Study 3 (MSS3) pragmatic randomised controlled trial

Highlights

• Persistent physical symptoms is a common problem, impacting patients’ quality of life with substantial costs to health services and society.
• This is the first economic evaluation to assess the value added by an extended-role GP symptoms clinic (SC) compared to UC in primary care.
• SC+UC has the potential to be cost-effective compared to UC alone in a 12 month time horizon, yielding increased QALYs at reasonable cost using a threshold £20 000 per QALY gained.

ABSTRACT

Objectives
To evaluate the cost-effectiveness of an extended-role general practitioner (GP) symptoms clinic (SC), added to usual care (UC) for patients with multiple persistent physical symptoms (sometimes known as "medically unexplained symptoms").

Methods
A 52-week within-trial cost-utility analysis of a pragmatic multicentre randomised controlled trial comparing SC+UC (n=178) against UC alone (n=176), conducted from the primary perspective of the UK National Health Service (NHS) and personal and social services (PSS). Base-case quality-adjusted life-years (QALYs) were measured using EQ-5D-5L. Missing data were imputed using multiple imputation (MI). Cost-effectiveness results were presented as incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits (INMBs). Uncertainty was explored using cost-effectiveness acceptability curves (using 1000 non-parametric bootstrapped samples) and sensitivity analysis (including societal costs, using SF-6D and capability ICECAP-A outcomes to estimate QALYs and years of full capability (YFC) respectively, varying intervention costs, missing data mechanism assumptions).

Results
Multiple imputation analysis showed that, compared to UC alone, SC+UC was more expensive [(adjusted mean cost difference: 704; 95% CI:£605, £807)] and more effective [(adjusted mean QALY difference: 0.0447 (95% CI:0.0067, 0.0826)] yielding an ICER of £15,765/QALY, INMB of £189.22 (95% CI:−£573.62, £948.28) and a 69% probability of the SC+UC intervention arm being cost-effective at a threshold of £20000 per QALY. Results were robust to most sensitivity analyses, but sensitive to missing data assumptions (2 of the 8 scenarios investigated), SF-6D and ICECAP-A quality of life outcomes.

Conclusions
A Symptoms Clinic is likely to be a potentially cost-effective treatment for patients with persistent physical symptoms.

Open access, https://www.sciencedirect.com/science/article/pii/S1098301524066452

 

So the same old nothing. The idea that this is effective, even cost-effective, is laughable. But almost no one seems bothered by that.

"Illness without disease". As they explain early on, this is what they perceive as 'somatization'. So, the exact same old nonsense with the same intent and purpose, the same methods and models.

Literally the same old nonsense, basically in the form of a GP consult, but longer, then offering 'explanations' about things they don't understand:

And as is tradition, the difference is not statistically significant, but they still think that even though it's more expensive, that it must be cost-effective and recommend it:

Mathematicians and physicists work with imaginary numbers, but physicians deal with really imaginary numbers. Well, that and lies, damned lies, and statistical analyses of really imaginary numbers.

And what is a clinic, if not a 'symptoms clinic'? Of course they mean symptoms with no physical cause they understand, which they prefer to think of as 'somatization'. Hey, this approach has failed for decades, maybe this time doing it exactly the same old way it will work*.

And of course this is a randomized trial but they call it randomized controlled because why not? It's not as if anyone cares about stuff like this anymore.

(* It won't)

 

Indeed

I saw this and thought of the phrase ‘playing the system’

and of course it’s these HCPs who are wanting to profit by knowing where the sales pitches are (not the patients getting immorally screwed over by this)

it never saves money

always makes patients worse and leads to numbers increasing and then the cheek is they use that failure as an excuse to say they need more money to do the same crap ‘because the issue is growing’

someone needs to get wise and regulate this pathway to conning ICBs full of busy people being smarmed and the tick boxes being played in a way reminiscent of the days of drug reps when they were allowed to give gifts or kickbacks or whatever it was

how are these people any different to that other than they are playing the money train from the inside?

 

It's mentioned in the text but they mostly shrug it off as "good enough", even though given that those were a small number of assigned GPs I don't think this excuse holds up well (6 GPs were involved, come on) but I doubt it would have changed anything and it's not as if any of this matters, trials like this always write themselves from the conclusion out. They are funded not to provide information but to make evidence up for that conclusion:

 

Gonna (presumably, if accurate) quote Gandhi here: "Methodological and ethical standards in psychosomatics? I think it would be a good idea".

 

I didn't bother calculating what it means but when you put it like that it's not just completely laughable, as you say this is about years/days of perfect health so it's not even valid since those are healthy years equivalent. It literally means nothing. This is at least as completely delusional as homeopathy, probably even more.

 

This seems to be so similar I didn't think it warranted a separate thread.

Multiple Symptoms Study 3 An extended-role general practitioner clinic for patients with persistent physical symptoms: a Randomised Controlled Trial, 2025, Burton et al

Abstract

People with multiple and persistent physical symptoms have impaired quality of life and poor experiences of health care. We aimed to evaluate the effectiveness of a community-based Symptoms Clinic intervention in people with multiple and persistent physical symptoms.Pragmatic multicentre individually randomised parallel group clinical trial.

Participants: Recruitment was between December 2018 and December 2021 in four areas of the UK. Eligibility was based on electronic health records, healthcare use and multiple physical symptoms (PHQ-15 between 10 and 20) which were not due to other medical conditions. Intervention delivery changed from face to face to online in 2020 in response to the pandemic.

Interventions: Participants were randomised to receive the Symptoms Clinic plus usual care (intervention) or usual care alone (control). The Symptoms Clinic is a short-term extended medical consultation-based intervention delivered over approximately 8 weeks. Objective: To test the clinical and cost-effectiveness of an extended-role general practitioner 'Symptoms Clinic' for people with persistent physical symptoms.

Outcome: The primary outcome measure was the PHQ-15 at 52 weeks post randomisation. Randomisation: Participants were randomised 1 : 1 using a centralised web-based system, stratified by study centre with random permuted blocks of varying sizes.

Masking: It was not possible to mask participants to their allocation. Outcome assessors who handled patient-reported questionnaires were masked to allocation.Numbers randomised: 354 participants were randomised into the trial: 176 to the usual care group and 178 to the intervention group. Numbers analysed: 132 participants in the usual care group and 144 participants in the intervention group were included in the analysis representing 77.8% retention.

Outcome: Mean (SD) PHQ-15 at baseline was 14.9 (3.0) in the control group and 15.0 (2.9) in the intervention group. At 52 weeks it was 14.1 (3.7) in the control group and 12.2 (4.5) in the intervention group. The between-group difference, adjusted for age, sex, baseline PHQ-15 and clinician effect was -1.82 (95% CI -2.67 to -0.97; p < 0.001) favouring the intervention.

Harms: There were no significant between-group differences in the proportions of patients experiencing non-serious (-0.03, 95% CI -0.11 to 0.05) or serious (0.02, 95% CI -0.02 to 0.07) adverse events. All serious adverse events were deemed unrelated to trial interventions. Economic evaluation: Cost-effectiveness analysis indicated an incremental cost-effectiveness ratio of £15,751/QALY.

Process evaluation: The intervention was delivered with high fidelity and was acceptable to patients. The intervention appeared to act through the hypothesised mechanism of explanation as a bridge from uncertainty about the cause to actions to manage symptoms.

Limitations and further research: The intervention was delivered by a small number of GPs in long consultations. Further research should examine wider implementation and how to integrate elements of the intervention into shorter consultations.

Conclusions: The Symptoms Clinic delivered by specially trained GPs leads to a clinically meaningful improvement in physical symptoms at 52 weeks and is likely to be a cost-effective addition to current care.

Open access

 

"Imagine a world"-based medicine isn't even adequate for this tripe, this is just insulting people's intelligence with marketing buzzwords. I have no idea what role journals and reviewers even play if they find this mindless word salad worth publishing.

But, yeah, those are basically identical studies. Damn this grift is too easy.

So, a clinic. This just describes most of what a regular GP clinic does, and the most common thing they see: people with symptoms.