CBT costs £176/session at Maudsley Hospital (one of trial centres). This translates to CBT not being cost effective when a QALY is valued at £30,000 in healthcare costs
Posted by tkindlon on 23 Feb 2014 at 02:37 GMT
This paper (1) says:
"The cost per hour of therapy was £110 for CBT and £100 for APT and GET"
and
"The healthcare costs per QALY gained for CBT and GET compared to SMC were below the cost-effectiveness threshold of £30,000. The cost of CBT would need to increase by 45% and GET by 22% for the cost per QALY to reach £30,000."
That is to say, the threshold for CBT to be cost-effective is £159.50 per hour of therapy.
As Ed Jackson has pointed out (2), the actual cost being charged at Maudsley Hospital, London (one of the centres for the CBT Trial itself) is £176 per session (pp.41, 3). In the PACE Trial, there was one session of 90 minutes and the other 14 sessions were of 50 minutes (4). This translates to average session length of 52.67 minutes if all the sessions are attended, slightly more if not all the sessions are attended. The £176 per session at Maudsley Hospital is quoted for 20 sessions. If all the sessions are attended, this would mean an average session length of 52 minutes. If fewer were attended, it would be slightly more. If one uses the figure of 52 minutes, that translates to CBT costing £203.08 per hour, a lot more than the threshold for CBT to be cost effective where a QALY is valued at £30,000. If one uses a more conservative figure of a session lasting 60 minutes on average, then it costs £176 per hour and is still not cost effective.
I thought I would highlight again an analysis promised in the statistical plan (5): "The estimated costs of APT, GET and CBT will be increased and decreased by 50% to see how sensitive the costs, cost-effectiveness and cost-utility findings are to these variables." Increasing the cost by 50% using such a sensitivity analysis, which wasn't explicitly reported in the cost effectiveness paper itself, CBT would not be cost effective. Such an analysis seems particularly relevant given the quoted cost of CBT in Maudsley Hospital.
References:
1. McCrone P1, Sharpe M, Chalder T, Knapp M, Johnson AL, Goldsmith KA, White PD. Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis. PLoS One. 2012;7(8):e40808. doi: 10.1371/journal.pone.0040808. Epub 2012 Aug 1.
2. Jackson Ed: Additional analyses from statistical analysis plan and trial's protocol should also be released.
http://www.plosone.org/an...
3. National Services Directory. A guide to our specialist mental health services for adults across the United Kingdom. April 2012 - March 2013
https://www.national.slam...
4. Burgess M, Chalder T. PACE manual for therapists. Cognitive behaviour therapy for CFS/ME.
http://www.pacetrial.org/... .
5. Walwyn R, Potts L, McCrone P, Johnson AL, DeCesare JC, Baber H, Goldsmith K, Sharpe M, Chalder T, White PD. A randomised trial of adaptive pacing therapy, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome (PACE): statistical analysis plan. Trials. 2013 Nov 13;14:386. doi: 10.1186/1745-6215-14-386