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A cost effectiveness of the PACE trial

Discussion in 'Latest ME/CFS Research' started by user9876, Aug 1, 2012.

  1. Esther12

    Esther12 Senior Member

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    Thanks.

    I can't remember if the PACE CBT manual includes stuff about 'overcoming a reliance on caregivers' type stuff. I've seen that sort of thing in other CBT plans...

    I just checked the shorter participants guide for CBT and found this:

    Ugh... I really felt dirty reading some of the other parts of that. I think that the more I read of this stuff, the more I hate it.

    More generally I think there would be a real danger that interventions founded upon models that assume patients have greater control over their symptoms would also be more likely to lead to a degree of response bias in questionnaires on the amount of support taken.

    I had a look though the APT participants guide and couldn't find anything similar.

    I don't think it's fair to assume that this would lead to people with APT to make use of more support, but I found it, so many as well post it here too.

    tbh, I didn't much like reading the APT guide either!
     
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  2. Dolphin

    Dolphin Senior Member

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    Yes, it's important to point out that the reliability of the whole supposed cost-effectiveness value for CBT and GET from a societal perspective largely depends on participants accurately reporting this one measure (as there wasn't much difference in anything else).
     
  3. Tom Kindlon

    Tom Kindlon Senior Member

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    My latest comment on the PACE Trial cost effectiveness paper:
     
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  4. Tom Kindlon

    Tom Kindlon Senior Member

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    I just posted another comment:
    http://www.plosone.org/annotation/listThread.action?root=78707
     
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  5. Dolphin

    Dolphin Senior Member

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    I just read:



    In the statistical analysis plan for the PACE Trial, one of the analyses mentioned was valuing the cost of informal care at zero. This was not reported in the paper proper.

    Also, in the
    This was not explicitly done but when the issue was brought up, Paul McCrone the corresponding author said the therapies were not cost effective if the estimated cost was increased by 50%. They were thus certainly not cost effective if they were increased by 100%.
     
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  6. user9876

    user9876 Senior Member

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    From an economics perspective it would be interesting to apply a supply and demand model to treatment costs since supply of treatment (being based on having trained staff) is not elastic and hence costs would be expected to increase (especially now we have a market for health in the UK). However, I seem to remember that the cost effectiveness was quite marginal so treatments would quickly become not cost effective.

    Also given the patient surveys showing serious deteriation with GET and CBT could they these costs be factored in and then their analysis would probably collapse.
     
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  7. Esther12

    Esther12 Senior Member

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    Has that been mentioned in the PLoS comments? I saw that some of these things had been.
     
  8. Dolphin

    Dolphin Senior Member

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    Yes, it has been.
     
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  9. Dolphin

    Dolphin Senior Member

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  10. Dolphin

    Dolphin Senior Member

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    It would be interesting to think of ways the PACE Trial data that was used in the cost effectiveness paper could be re-analysed. If anyone has ideas, feel free to share.
     
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  11. Mark

    Mark Acting CEO

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    It occurred to me that it might be an interesting idea to prepare a public plan for re-analysis of the data ahead of its release. I wonder whether it would be a good idea to specify the protocol for re-analysis ahead of time? That way, you might pre-empt the inevitable claims that you have done a post-hoc analysis, cherry-picked to make it look the way you want it to look. Would there be any way to publicly specify and review some of the analyses we might wish to do with this data? After all, that's what we demand of regular science for it to be considered valid.
     
  12. Simon

    Simon

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    Good point. One obvious way to reanalyse the data, of course, is as defined in the authors' published protocol. That way is totally free of bias or any cherry-picking. James Coyne could simply say in a blog how he planned to analyse the data if that blog is published before the data is released.

    And of course, you can always do further analysis once you have the data, but it's good practice to make clear that this is exploratory analysis.

    From memory, when James Coyne has re-analysed stuff before, or even commented on published data, he's focused on using the obvious eg for the PACE trial emphasising the difference between treatment groups at long-term follow-up ie good practice, rather than rummaging around looking for quirky stuff.
     
    Last edited: Dec 13, 2015
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  13. user9876

    user9876 Senior Member

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    An interesting analysis would be to compare the QALYS scores for different countries. Each has different norms as to how they fit to the raw Eq5d data and given their was only a small difference (0.05) and only significant for CBT I wonder if this is true in all countries. There have been papers pointing out issues with the EQ5D scale when different county norms are applied as it leads to different results. Following this line of reasoning it would be interesting to look at sensitivity of the results to small changes in the model - if I remember correctly the norms for the UK were generated using a linear regression over survey data where some of the residuals were more that the 0.05 (but its along time since I read about this) and I have often wondered how potential measurement errors should effect significance (I assume the larger the error in the measurement system the harder it is to conclude a significant result). So an analysis with slight variations of the model would be interesting.

    More generally I felt that they should have quoted the individual dimensions of the eq5d scale which seems to be a common (if not recommended) reporting practice. Ideally these could be correlated with other measurements. I am a big believer that all variables should give a consistent picture or a good explanation is needed so for example the mobility dimension in the eq5d scale should correlate with the 6mwt, fitness test as well as mobility elements of the sf36-pf scale. If not there must be doubt over the validity of some of the scales and results when applied in this context (e.g. with interventions aimed at changing perceptions of abilities).
     
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  14. Dolphin

    Dolphin Senior Member

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    This may have been mentioned before:
    In the statistical analysis plan (which came out after the cost effectiveness paper was published), the PACE Trial investigators said they would:

    What they actually did was

    Initially I had interpreted the £14.60 figure as something they had said they would do. However, what they actually said they would do was use "the cost of a homecare worker". I would imagine that the cost of a homecare worker would be less than the figure for national mean earnings and so it looks to me on this reading that the £14.60 figure is completely new.

    I have forgotten at this stage what has been discussed in the comments on the PLoS one site so perhaps this exact point has been made?
     
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  15. Dolphin

    Dolphin Senior Member

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    I had previously wondered what the following referred to:

    I believe I have now figured it out.


    However this is not controlling for baseline scores.

    In terms of raw scores, 5 more people in the APT group were receiving income benefits at the end compared to 3 in the CBT group. This difference wouldn't be significant.

    The differences at baseline were nearly significant:
     
    Last edited: Mar 29, 2016
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  16. Dolphin

    Dolphin Senior Member

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    Some other calculations that were not statistically significant.

    Table 3:


    http://www.graphpad.com/quickcalcs/ttest2/

    -----


    I stuck the data from the left of Table 2 into a statistical calculator and using a t-test, it wasn't close to being statistically significant:


    http://www.graphpad.com/quickcalcs/contingency2/


    I stuck the data from the right of Table 2 into a statistical calculator and using a t-test, it wasn't close to being statistically significant:


     
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  17. Dolphin

    Dolphin Senior Member

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    http://www.virology.ws/2016/05/23/an-open-letter-to-plos-one/

    ---
    New Phoenix Rising thread:
    http://forums.phoenixrising.me/inde...niello-et-al-an-open-letter-to-plos-one.44771
     
    Last edited: May 23, 2016
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  18. Dolphin

    Dolphin Senior Member

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  19. Bob

    Bob

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    Is anyone able to tell me how they calculated the informal care costs, for their main analysis, please?
    i.e. which figures in the paper did they use for the number of hours per year, and what hourly rate did they use. (They give a gross rate £14.60)
    I'm unable to get the numbers to add up.
    Thank you.
     
  20. Keith Geraghty

    Keith Geraghty

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    I imagine the health economist applied costs from a table of disability i.e. projected hours needed to care for patients and then applied an arbitrary cost per hour eg £14.60 which I think works out as the average hourly salary for a UK mean salary. However, the median or modal salary would be much lower, if you took away the high earners, the average salary would fall from say £28k per annum to a more likely modal salary of £17k per annum, thus the average hourly rate would fall to say £10.50 per hour. The whole thing is makey uppy (in design and stats calculations). You are assuming CBT and GET reduced the need for care and APT had an increased need for informal care --- whereas Ive long argued that only those in the most severe category the 20% worse sufferers require paid or full time care from family who stop working - in the mild to modearte 80% family and friends would most likely work around jobs to offer care, or find a family member not working to offer care. Now remember PACE included mainly mild to moderate suffferers (the ones well enought to do the therapy) so we can safely assume we are talking about applicability to mild to moderate sufferers -- yet McCrone using national disability tables assumed care needs for the entire population based on projections of need.He then applied an hourly rate for this care in terms of lost employment. But If I had a sick ME son or daughter, Id make sure they where ok in the morning, feed them, go to work, have my phone on standbye, have a neighbour close by and then be home on time to feed them and make sure they are ok. Only the very severe have paid carers. Ironically if you got paid more than the £14.60 eg youre a laywer on £50 an hour, youd pay a care assistant for £7.60 an hour to help your son or daughter, or youd paid a care company £15 an hour. If you were on a very low salary or could have your son or daughter classed as disbaled in need of care you could apply for carers benefit. Perhaps McCrone also counted these as societal costs, ie the state paying carers instead of them working -- but no matter what way he costed it, it was based on a false assumption regarding differences in need between CBT - GET - APT, which were wrong, so cost effectiveness might also of fallen down if he used a more accurate modal salary rate..
     
    Last edited: Jun 8, 2016

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