A cost effectiveness of the PACE trial

Can anybody think about this. They say they

. This presumably means that the higher the initial costs, the bigger the savings expected, and this is controlled for. However, would the trend be so big that it would likely make such a difference given the following: if one looks at APT, it had the second highest informal care costs initially and it reduced the least?

Oh the irony, considering how White has lead us up a blind alley of his own with the cognitive behavioural model of CFS (functional somatic syndrome predominantly perpetuated by unhelpful illness beliefs and deconditioning), and after the PACE results even the stubborn MRC are now shifting the funding towards biomedical research.

Well spotted Dolphin. I can't understand how they could adjust the difference from £237 to £1165 or from £408 to £1173. It seems far-fetched.

There do seem to be quite a few apparent inconsistencies in this paper, based on the adjusted sums.
I'm also surprised that, for Societal costs ("i.e. healthcare, informal care and lost production costs"), they say there are no statistical differences apart from CBT vs APT.
Because Simon's comparisons with SMC seem fairly substantial, for CBT vs SMC at least:
Total societal costs APT 1,592 CBT -532 GET -244 SMC 0

And my figures, which are the differences between adjusted totals, in Table 3, still seem quite substantial for CBT vs SMC at least:
Total societal costs APT 1617 CBT -464 GET -197 SMC 0


Edit:
But, there again, individual societal savings, per person improved, and per QALY gained, might be statistically different, which adds more layers of confusion!

I've been wondering about fig 1 and fig 2. The x axis is for the amount that the governemt is prepared to spend for a QALYs. So if they are not prepared to spend anything then clearly SMC has a probability of 1 of getting sucess. As we move from the edge case then you look at the probability that you get a better treatment given the spending constraint. My guess is costs are fixed and so that they are doing is looking at the probability distribution for QALYs and asking which is most likely to deliver the QALYs gain necessary to get to the threshold cost. I've not managed to work out how they do this as I'm not sure if the graph shows individual values or if they all the points for a given threshold add up to 1.

Yes, my thoughts about it are similar. And I can't work out what calculations they've used. I'm interested to find out how/why SMC goes from a probability of 1, to almost zero.

The only explanation I can find is (if it is the relevant explanation):

"Interpretation of the cost-effectiveness results was made using
cost-effectiveness acceptability curves [18]. Net benefit values were
computed for each study participant, defined as the value of a
QALY multiplied by the number of QALYs gained minus the cost
(from both healthcare and societal perspectives)."

(There's a bit more text after that quote in the paper, about how they fit the values into the graphs.)

RE: measuring fatigue/disability improvements:

No idea how such categorical issues are dealt with in general, but like you I do wonder if it's normal to show cost-effectiveness calculations for "minimum useful differences".

Ah, as always, good to see the underlying questions. If SSP was included as a benefit (despite being payed by employers) then there wouldn't be such a time delay for people with CFS getting on benefits - SSP is straightforward to claim. On the other hand, many employers give sick pay at a much higher rate (mine did initially) in which case people may not be aware part of their salary is "SSP" if they continue to be paid at their normal rate. So they might not say they were on SSP.

If you are comparing using Table 6, note that individual costs for informal care are not given but instead they give 'Societal' costs which also includes employment. I have a feeling that employment losses were diferent for APT and that might complicate the situation.

Also, the differences in societal costs are not significant between CBT/GET and SMC, so that's two statistically insignificant figures that they've used in that section, in order to work out that GET is dominant over SMC.

No, I was replying to this (raw figures are from Table 3):

But I couldn't see any figures for baseline-adjusted informal care costs for APT vs SMC which were the basis for the comments I made re CBT/GET. Did I miss them?

You've lost me now.
In this comment: http://forums.phoenixrising.me/inde...s-of-the-pace-trial.18722/page-10#post-285886 I was commenting on this comment by myself, where there is no mention of APT:

wow

thx for info, D

Has anyone had any joy with Figure 1 yet?

I still can't work it out.

It seems to me that, for Figure 1, values for SMC and GET should be roughly identical when a QALY is valued at around £20,000, because the two lines cross over on the graph at £20,000.

If the relative value of SMC is 'zero' (and I'm not certain about this), then I think that the relative net benefit for GET should be valued at about 'zero' when a QALY is valued at £20,000.

Figures 1 & 2 come from a statistical technique called bootstrapping. An educational article on it is at: http://www.stat.rutgers.edu/home/mxie/RCPapers/bootstrap.pdf . Basically, it means one doesn't have to know what type of distributions the data takes (e.g. Normal distribution, Poisson Distribution, etc.), one just uses a computer to sample randomly from the data one has, get the computer to do this numerous times, and collate the results. This means one doesn't have to do any fancy mathematical calculations to work out what a model suggests the results should be.

I have come across the technique a few times (i.e. am no expert), however, my impression is the problems advocates are likely to have with the paper are not here. [Although, as I pointed out before, if one removed CBT from the figures, SMC wouldn't have such low percentages (for a lot of the graph)].

how likely is it that carers would make the mean national wage? shouldn't they use the mean wage of women? (more carers would tend to be women) (which would account for those who might chose not to work anyway and those who would get paid less - or do you not have a men/women wage difference in UK?) and rather than using mean, shouldn't they use a median or something like that?

ETA: I see this has been partially mentioned already -

Research 1st: The PACE Study Dollars and Sense:

8 August 2012: http://www.research1st.com/2012/08/...&utm_campaign=Feed: Research1st (Research1st)

Am reading it through now. Just got the alert. Gods know what the 'Sense' refers to

This is Kim McCleary of the CAA. There are some very good points in there whatever you think of the CAA.

Using the mean seems strange.

If it is true that ME is more prevelant in men then women I'm not sure it makes sense to use the mean or median wage for women.
An alternative option would be to use the wage paid to someone working as a carer. I suspect this is just over the minimum wages.

In terms of societal costs spending money on carers isn't that big a cost, money recirculates around the economy. They really big cost is the opportunity cost - that is what would people with ME and their families be able to do if they weren't ill. These are very hard to estimate and I suspect won't change with small changes in levels of disability,

Yes. Not as thorough as perhaps might have been liked. Still it did make some good points as you say, Alex.