Cost-effectiveness of Interventions for Chronic Fatigue Syndrome or Myalgic Encephalomyelitis: A Systematic Review.., Cochrane, Crawley et al, 2021

Andy

Andy

Retired committee member
Full title: Cost-effectiveness of Interventions for Chronic Fatigue Syndrome or Myalgic Encephalomyelitis: A Systematic Review of Economic Evaluations
Introduction

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has profound quality of life and economic consequences for individuals, their family, formal services and wider society. Little is known about which therapeutic interventions are more cost-effective.

Objective
A systematic review was carried out to identify and critically appraise the evidence on the cost-effectiveness of CFS/ME interventions.

Methods
The review protocol was prespecified (PROSPERO: CRD42018118731). Searches were carried out across two databases—MEDLINE (1946–2020) and EMBASE (1974–2020). Additional studies were identified by searching reference lists. Only peer-reviewed journal articles of full economic evaluations examining CFS/ME interventions were included. Trial- and/or model-based economic evaluations were eligible. Data extraction and screening were carried out independently by two reviewers. The methodological quality of the economic evaluation and trial were assessed using the Consensus Health Economic Criteria checklist (CHEC-list) and Risk of Bias-2 (RoB-2) tool, respectively. A narrative synthesis was used to summarise the economic evidence for interventions for adults and children in primary and secondary care settings.

Results
Ten economic evaluations, all based on data derived from randomised controlled trials, met our eligibility criteria. Cognitive behavioural therapy (CBT) was evaluated across five studies, making it the most commonly evaluated intervention. There was evidence from three trials to support CBT as a cost-effective treatment option for adults; however, findings on CBT were not uniform, suggesting that cost-effectiveness may be context-specific. A wide array of other interventions were evaluated in adults, including limited evidence from two trials supporting the cost effectiveness of graded exercise therapy (GET). Just one study assessed intervention options for children. Our review highlighted the importance of informal care costs and productivity losses in the evaluation of CFS/ME interventions.

Conclusions
We identified a limited patchwork of evidence on the cost-effectiveness of interventions for CFS/ME. Evidence supports CBT as a cost-effective treatment option for adults; however, cost-effectiveness may depend on the duration and frequency of sessions. Limited evidence supports the cost effectiveness of GET. Key weaknesses in the literature included small sample sizes and short duration of follow-up. Further research is needed on pharmacological interventions and therapies for children.
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Open access, https://link.springer.com/article/10.1007/s40258-021-00635-7
 
If some thing does not work, how can it be cost effective?

Give there is some evidence that UK specialist ME/CFS services primarily providing CBT/GET result in people working fewer hours and claiming more state benefits is this ‘research’ completely barking up the wrong tree.
 
This is literally made-up of imaginary numbers presented haphazardly without making any sense. It doesn't take into account most of the costs and so literally doesn't do an actual cost-effectiveness. And obviously something that is not effective cannot be cost-effective.

It quite literally argues that it is cost-effective without presenting any actual evidence, there is no actual calculation being done. Even when they have to use real numbers, dollars, they can't. Then suggests more research is needed since it can't actually conclude anything, simply says so.

This is sick. These people play with millions of lives like we are mere ants in their garden. It's absolutely disgusting the complete disregard they have for our lives.
Further research is needed to establish the cost-effectiveness of therapies for CFS/ME, including larger studies to assess whether the potential cost effectiveness of fatigue self-management in adults and the lightning process in children can be replicated.
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Not the generic "of therapies". Which one? Nobody cares. Complete free-for-all. It's been used in practice for over 2 decades, they can't deny that there is no evidence whatsoever and still they argue for it, promote it. Grotesque.

This is a level beyond lies, damned lies and statistics. The statistics don't even support that and they just say whatever they want because nobody cares, nobody checks the substance here, they merely skim and nod. I am 100% certain that no one but the authors actually read the paper, including the reviews. A quick 5-minute cursory glance and that's it. This is Potemkin medicine, completely hollow.
 
Selection of the Reported Result
Just under half of the studies referred to a prespecified analysis plan and confirmed that the plan had been finalised before the outcome data had been analysed [19, 20, 24, 27]. For the remaining six studies, there was insufficient detail to assess the analysis intentions.
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20 is PACE. There was something in their cost-effectiveness paper that was missing, wasn't there? And we're still waiting for LTFU data of course.

They actually say:

In these three studies, the cost of CBT itself was in the approximate range of £1000–£2000 per patient, representing a substantial investment. This investment may well represent very good value for money if the initial improvements in fatigue and health-related quality of life are sustained in the long-term, particularly if this is accompanied by lower health service use, informal care needs and higher return to work. Long-term follow-up from the PACE trial [40] demonstrates that the advantage of CBT and GET over the comparator groups on fatigue and physical function narrowed over time, highlighting the need for longer-term economic analyses.
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I wonder who will be providing this good quality evidence?:

Access to specialist CFS/ME care is already limited in many settings and the type of care provided is highly variable [41]. In order to increase access, novel approaches are needed to provide stepped access to low- or high-intensity CBT and GET provided by appropriately trained therapists in primary care settings [42] and/or using remotely delivered (e.g. internet-based) therapy methods [43]. These new services are being established, partly in response to the coronavirus disease 2019 (COVID-19) pandemic, but they will require careful evaluation to determine whether efficacy is maintained and whether efficiency increased [44, 45]. We note that several economic evaluations of such services in adults [46] and children [47, 48] are currently underway. Good economic evidence to support treatment options in children is particularly important as current therapy is largely based on the assumption that findings from adults can be generalised to children.
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Fascinating that cost of care is being taken into account when there are no effective treatment. I wonder whether Crawley and her buddies would like to move on to diseases that spends millions if not billions in very expensive drugs.

We haven’t cost the health care system much, if at all because often times it is not even safe to see a doctor.
 
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