Cost-utility analysis of transdiagnostic [CBT] for people with persistent physical symptoms in contact with specialist service... 2024 McCrone et al

[Andy]

Full title: Cost-utility analysis of transdiagnostic cognitive behavioural therapy for people with persistent physical symptoms in contact with specialist services evaluated in the PRINCE secondary trial

Full list of authors: McCrone, Patel, Hotopf, Moss-Morris, Ashworth, David, Husain, James, Landau, Chalder

Highlights

• CBT for people with persistent physical symptoms increased healthcare costs.
• Health-related quality of life and QALYs were greater with CBT.
• CBT appears to be a cost-effective treatment option.

Abstract

Objective
To compare the cost-utility of transdiagnostic cognitive behavioural therapy (TDT-CBT) plus standardised medical care (SMC) to SMC alone to support people with persistent physical symptoms in contact with specialist services.

Methods
This study compared the cost-utility of TDT-CBT. A two-arm randomised controlled trial was conducted in secondary care settings. Participants received either TDT-CBT + SMC or SMC alone. Measures were taken at baseline and at 9-, 20-, 40-, and 52-week follow-up. Service use was measured, and costs calculated. Costs were combined with quality-adjusted life years (QALYs) based on the EQ-5D-5L using incremental cost-utility ratios with uncertainty addressed using cost-effectiveness planes and acceptability curves.

Results
The costs during the follow-up period were £3473 for TDT-CBT + SMC and £3104 for SMC alone. The incremental cost for TDT-CBT + SMC adjusting for baseline was £482 (95 % CI, −£399 to £1233). QALYs over the follow-up were 0.578 for TDT-CBT + SMC and 0.542 for SMC alone. The incremental QALY was 0.038 (95 % CI, −0.005 to 0.080). The incremental cost per QALY was £12,684 for TDT-CBT + SMC. There was a 68.3 % likelihood that TDT-CBT + SMC was the most cost-effective option at a threshold of £20,000 per QALY.

Conclusion
Adding TDT-CTB to SMC results in slightly increased costs and slightly better outcomes in terms of QALYs. This represents a cost-effective option based on the conventional QALY threshold value.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0022399924003726

 

[Sean]

slightly increased costs and slightly better outcomes in terms of QALYs

And based on a single subjective measure of clinical benefit.

Now they are just taking the piss.

 

[rvallee]

As impressively delusional as ever, just fiddling around with imaginary numbers. Seems to be the current strategy is to fake numbers in terms of RoI and framing them explicitly as reducing direct health care expenses. Lots of those lately. Hey it's not as if LC alone is estimated in the trillions or anything like that.

They exclude the costs of the interventions, and still it adds to overall costs. I don't know who else can do that, ignore the initial investment, but I guess that when nothing matters, nothing truly matters. Hey, if I ignore the cost of buying the printer and only count the cost of the ink, it's cheaper to buy a new printer. OK actually it costs the same. Do not add all the numbers up, though. Just accept that it's cost-utilitiarian. Even though it's literally useless.

Also here they basically describe cherry-picking, but again nothing matters so whatever:

Although we didn't see a significant treatment effect on the primary outcome (WSAS) at 52 weeks there was a difference at 20 weeks which corresponded to the end of therapy

STOP THE COUNT! If my team is ahead by one goal 15 minutes before the end of the game, it must be marked as a victory. Obviously.

Oh, I love this. Remember how they keep writing about how it's unfair that NICE changed application of CBT as merely supportive?

To compare the cost-utility of transdiagnostic cognitive behavioural therapy (TDT-CBT) plus standardised medical care (SMC) to SMC alone to support people with persistent physical symptoms in contact with specialist services.

Treatment options are varied. In the absence of clearly identified biomedical explanations which may be addressed through medicinal interventions, support through psychological interventions specifically tailored to reducing the impact and severity of symptoms may be helpful

Wow they must be mad at themselves here, for saying that it's merely supportive and not curative. I guess they'd argue that this is transdiagnostic so not for for CFS, it just happens to also apply to CFS.

Again, nothing matters in this pseudoscience. It's not even that up is down and down is up, it's that they are whatever they need to be at the present moment, including west, red and both hot and cold at the same time. Also, for some reason, 5:55 but only PM, not AM.

Such conditions include chronic fatigue syndrome, irritable bowel syndrome, and fibromyalgia

Ah, well, nevertheless.

Also, 'specialist' services for 'transdiagnostic', i.e. generic, modalities? They are generic specialists? Specialists of generics? How does that even work?

And as usual they call this a controlled trial when it isn't controlled. Or somehow this wasn't just a randomized trial but also a combined meta analysis and systematic review? Wut? Why those specific 18 trials when there have been hundreds? I sure hope you like cherry pie because they got bushels of them.

To assess whether CBT reduced health care costs a systematic review and meta-analysis was conducted using data from 18 trials. Small reductions in healthcare contacts and medication use were found for CBT compared with active controls, treatment as usual and waiting list controls. However, there were no reductions in medical investigations or healthcare costs [9].

So, no reduction in costs. From terrible biased data. Which probably actually means an increase in costs, given who we are talking about here. And examples such as this nonsense study where they exclude the cost of the intervention by only counting post-intervention costs. Things you can only do when you are exempt from making sense or respecting norms.

They 'developed' another model?

Given the overlap in some of the cognitive behavioural factors which perpetuate syndromes including irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia we developed a transdiagnostic approach based on a theoretical model that assumes that common processes can be targeted simultaneously across symptom clusters with a view to reducing symptoms and improving quality of life. We called this approach transdiagnostic CBT (TDT-CBT). We evaluated the approach in the context of a randomised controlled trial [10].

Which is the same model. They sure do love developing the same model over and over again. But in the highlights they simply call it CBT. Because it's basically like a book with blank pages, it does not matter what's in it, no one even cares. Only the cover, binding and the fact that it has pages made of paper.

Races to the bottom always lead you to the same outcome: the absolute bottom. They're still digging so they basically constantly redefine the bottom.

 

[NelliePledge]

Have they ever set out what is supposed to be involved in this “standard medical care”. Because as most of us know in real life standard medical care is about £0.