I'm trying to summarise the most interesting data published in the PACE Trial's cost analysis paper.
Before I try to make my summary more succinct, I'm posting my analysis so far.
If anyone is able and willing to, I'd be very grateful for any feedback, please.
(i.e. Have I made any obvious and glaring errors?)
I'll have to study the whole paper again, to make sure I haven't made any mistakes, and I'm obviously not expecting anyone else to give that sort of detailed feedback.
Cost Effectiveness Analysis paper:
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0040808
Please note that I am ignoring APT in this analysis, so where-ever I say that there were 'no significant differences', etc., between treatment groups, this might not always apply when comparing the therapy groups to APT.
Lost employment hours
They've given us lost employment 'hours', and lost employment 'costs', but not details of number of individuals back to work, or the number who increased working hours.
Lost employment 'days' are given in Table 2, and lost employment 'costs' are given in Table 3.
The paper says that CBT and GET did not improve employment prospects:
"
There was no clear difference between treatments in terms of lost employment."
Note that there were lost employment
improvements in the CBT, GET
and SMC groups, but the differences between CBT/GET and SMC were not significant, so CBT/GET did not improve outcomes.
Table 4: Welfare Benefits and Other Financial Payments
http://www.plosone.org/article/info...RI=info:doi/10.1371/journal.pone.0040808.t004
Note that these figures (for benefits) are
not included in the cost effectiveness evaluations.
So although this data is published, it isn't used for any analysis.
I think that the 'benefits' data is the only 'cost' data in the paper that is excluded from the final analysis.
For the
overall differences, for
all (welfare
and private) 'benefits', taken as a whole, the paper seems to assert that there was
no significant difference between the CBT/GET groups and the SMC control group, although it's not very clear what
exactly they mean by 'benefits' in the following text (
I think they are lumping all private and welfare benefits together.):
"
However, with the exception of a difference between CBT and APT, there were no significant differences in either lost work time or benefits between the treatments during follow up. In fact, benefits increased across all four treatments."
Note that they say that "
benefits increased across all four treatments." (So, overall benefits increased after treatment with GET and CBT, as well as with SMC.)
So, for
overall benefits claims (all welfare and private benefits, lumped together), there was an
absolute increase in the proportion of participants making claims, in
each of the therapy groups.
For both 'income-related benefits' and 'income protection schemes or private pensions', the increases in claimants for CBT/GET are higher (worse) than for SMC, but they just say that the differences were not 'substantial'. They don't say that the differences are not significant, so the outcomes for CBT and GET might be significantly worse, when compared with the SMC control group, in both of these benefit categories.
Interestingly, there is no data specifically in relation to 'private medical
insurance' claims. They only publish data for income protection schemes, and private pensions. I don't know if they collected data for private medical insurance. If they did, then perhaps the data wasn't to their liking, because they didn't include it.
Here is a breakdown of the individual types of benefit claims (it includes private 'benefits'):
Income-Related Benefits:
The proportion of participants claiming Income-related benefits increased in every therapy group.
Looking at the unadjusted figures, there is little difference between the changes in each therapy group (CBT, GET, and SMC), so it looks like CBT and GET made no significant difference to income-related benefits.
The text says:
"Relatively few patients were in receipt of income-related benefits or payments from income protection schemes and differences between groups were not substantial."
Illness/disability benefits:
The proportion of participants claiming illness/disability benefits increased in each therapy group.
By my estimation, using the unadjusted figures, CBT & GET resulted in a relatively lower increase in numbers on illness/disability benefits, when compared with the SMC control group (i.e. CBT and GET resulted in a less bad outcome in relation to SMC, but there was still an absolute increase in the CBT and GET groups). By my estimation there was about a 12 or 13 percentage point less of an increase for CBT/GET than for SMC.
The paper doesn't comment on this. It just says:
"Receipt of benefits due to illness or disability increased slightly from baseline to follow-up (Table 4). Patients in the SMC group had the lowest level of receipt at baseline but the figures at followup were similar between groups."
They seem to be looking at absolute numbers claiming benefits in each group, rather than the relative changes in numbers claiming benefits in each group over time. So they completely fail to comment on the relative changes in illness/disability benefits. Maybe there's no statistical significance but they don't make that clear.
So for Illness/disability benefits, there were absolute increases for CBT and GET, but relative lower increases for CBT/GET than for SMC. The paper doesn't seem to comment about whether the differences between the changes in each groups are significant in this category, so I can't comment.
Income protection schemes or private pensions:
The proportion of participants claiming for income protection schemes or private pensions was higher in every therapy group.
And CBT and GET both resulted in relative increases in claims, compared with SMC, (but I don't know if they are statistically significant increases), in the private benefits category (payments from income protection schemes or private pensions.)
(Using the unadjusted figures, there was roughly a 4 to 6 percentage points increase in participants making claims in the CBT and GET groups, compared with SMC.)
Keeping in mind that at least one of the authors works for an insurance company, the paper avoids
commenting on the increase in payments from income protection schemes and private pensions, as a result of CBT and GET:
"
Relatively few patients were in receipt of income-related benefits or payments from income protection schemes anddifferences between groups were not substantial."
(Note, that they do not say that the differences were not 'significant', they just say 'not substantial'! Crafty!)
I'll try to make a succinct summary soon, but in the mean time, here's a temporary very-brief summary, which I
think is safe enough to use, considering the lack of detailed
analysis for each benefit category, in the published paper.
(My issue with the following summary is that I'm not sure if the differences between therapy groups are
insignificant if we separate 'private payment claims' from 'welfare benefit claims' - there might only be insignificant differences between the therapy groups when all the 'benefit' categories are lumped together.)
Brief summary:
Considering the lack of detail in some of the cost-analysis paper's analysis, it seems safe to say that CBT and GET have
not resulted in significant improvements in:
1. Employment hours,
2. Welfare benefit claims (consisting of income-related, and illness/disability benefits), or
3. Private payment claims. (consisting of payment protection insurance, and private pensions.)
CBT and GET actually resulted in worse outcomes (when using SMC as a control group) for private payment claims (private payment claims seem to consist of: payment protection plans, and private pensions.)