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A cost effectiveness of the PACE trial

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

  1. Firestormm

    Firestormm Guest

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    Dr Enlander left a comment on the MEA Website beneath the 'immediate response' from Dr Shepherd viz:

    http://www.meassociation.org.uk/?p=12350

     
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  2. alex3619

    alex3619 Senior Member

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    Hi Firestormm, I have left a comment at that site though its waiting moderation. Bye, Alex
     
  3. Simon

    Simon

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    Thanks for this. Think you'd asked before about evidence for the '25%' severely affected rate - the NICE report you link to there has this: still no hard evidence but at least a published figure.
     
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  4. alex3619

    alex3619 Senior Member

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    Snow Leopard, more than three trillion pounds? My gift basket idea is sound much better.

    biophile, I agree with you on the reasoning in your last par in post 39, but so far public authorities/government have seemed oblivious to reason. The reasoning is good, but its not getting through. So what is at issue is whether or not it is blatantly obvious that we need biomedical research. It is to us, it should be to them, but for some reason it isn't, or at least not obviously. It is very likely that many are aware of the issues but they are not acting. That is part of what I am trying to understand. What influences/factors are preventing people from acting? The possibilities range from ideology to ideas about limitations of responsibility, to counter-forces that try to keep people in line with policy. As far as medicine is concerned the direction I am currently heading is that it is due to a combination of dogma and heavy compartmentalization of authority. Given that the UK has hamstrung control of the medical profession by medical professionals, and made it bureaucratic, I wonder if this is not in part why psychobabble has such a hold in the UK?

    Another point of major concern is this: how many countries around the world are putting money into biomedical research on ME or CFS? There seem to be only a small number. Why is that?

    I have been saying for years now that the lack of proper investment into biomedical resaerch is the equivalent of accumulating a huge debt, with interest, that will have to be paid some time in the future. The bad news is this debt will still have to be paid even in countries that go bankcrupt and so avoid current financial debt. These are not problems that are going to go away.

    One of the concerns we have in the modern world is the rising cost of healthcare. We complain, we want to cost cut, but we are unwilling to put money into research to deal with the issues. Not dealing with real problems does not make them go away, it just accumulates issues so they become even more serious. This is head in the sand thinking leading to potential catastrophe.

    Bye, Alex
     
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  5. user9876

    user9876 Senior Member

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    From an economics perspective this is an interesting point. With a drug therapy you would expect as demand increases economies of scale to apply and unit costs to reduce. However with a labour intensive therapy as demand increases this will effect the cost of supply. I'm not an economist but I would expect pricing to depend on the elasticity of the supply. That is how easy is it to get and train suitable therapists. A lack of supply would be expected to push costs up. Ok this may not work with salaried employees in the NHS but if the treatments were effective then you would expect some movement towards the private sector thereby increasing cost.

    There analysis suggests a cost increase of 22% for GET and 45% for CBT would push the treatments beyond the threshold.

    Ok this assumes the treatments have some effect I notice they didn't do a sensitivity analysis around errors in estimates of the effectiveness of their treatment.
     
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  6. user9876

    user9876 Senior Member

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    There seems to be a fair bit of research on the immune systems, auto immune diseasases etc. A number of such papers have been discussed on other threads. My hope is that fundimental research into the immune system, viruses and autoimmunity will be applicable to ME.
     
  7. Esther12

    Esther12 Senior Member

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    re the cost of treatment: They seem to want to use this as an argument for training more therapists - is the cost of this tr5aining included in the calculation of cost effectiveness? Pension costs of the staff involved? Anyone know what's normal?
     
  8. user9876

    user9876 Senior Member

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    I know for research grants we include pension costs with wages but that is in the private sector. I'm not sure how the NHS accounts for pensions.

    More generally, particularly with GET they need to make a business case that they can keep costs down. I beleive physios do a 3 year degree (funded by the NHS) and have a choice of areas to work in.
     
  9. user9876

    user9876 Senior Member

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    In the paper one of the advantages they talk of is in the reduction in social cost for CBT and GET but given
    It could be that there is reporting error as people don't like to admit that they have had more help or are subsitituting activity.

    Looks like they are trying to justify investment in training therapists based on a reduction in societal costs which given benefits increase must be the reduction in informal care and the reduction in working hours lost.
     
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  10. Bob

    Bob

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    The (only) other official place that I've seen the 25% figure quoted, is as follows:


    And here's another quote from the NICE guidelines:

     
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  11. Firestormm

    Firestormm Guest

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    Re: Increasing costs of therapy

    Answer: I would expect to hear in the coming months a proposal to switch from face-to-face to internet based CBT/GET therapy

    I won't go into the move in general that is occurring for telephone services, IT health check systems, and internet/email therapy. I think there's been more than enough coverage. But this is where I would expect them to go next. And that would see the massive savings whilst enabling them to say that they were 'doing something'.
     
  12. Dolphin

    Dolphin Senior Member

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    http://www.bps.org.uk/news/behavioural-therapies-can-help-me

    Behavioural therapies can help with ME

    03/08/2012
    It wasn't as if all the other posited treatments were tested!

    Having an effect is completely different from "working" which sounds like therapy is sufficient, which it wasn't.

    I would look at what he says in a slightly different way and wonder whether the therapies and factors associated with them influence responses/have different effects on self-report measures. As people will recall, there was no difference between CBT, APT and SMC alone on the 6 minute walk test.
     
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  13. Simon

    Simon

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    Thanks, Dolphin.

    I was intrigued by some of Hyland's comments suggesting that the greater hope/recovery focus of CBT/GET may account for their greater 'effectiveness' than APT, a point that I think has been argued on the PACE thread before:
    Of course, the same factors could also lead to more positive reporting as opposed to more real-world effectiveness, as you suggest
     
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  14. Esther12

    Esther12 Senior Member

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    So much of the excitement over the wonderful positive power of placebo seems to require people fail to account for the fact that manipulating what people say about something isn't a terribly worthwhile thing for a doctor to do. If a patient feels that they have a good relationship with a therapist, they'll be more likely to say their treatment was helpful... people are more likely to give positive reports about the work of a plumber they like too! If people feel that they have been working towards an improvement in their health, and have invested their time and ego in to achieving this goal, they'll be more likely to report an improvement in health.... people want to feel pride in themselves and their actions... so what? If patients are still facing a reduced capacity, then the real problem remains, regardless of the positive delusions which have been instilled.

    The evidence from actometers used to assess the impact of CBT would seem to indicate that it fails to have any impact upon the reduced capacity of patients. If that's the case, then it is not a medical treatment for CFS, it is just a political tool of manipulation.
     
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  15. user9876

    user9876 Senior Member

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    Even believing their figures in this paper the EQ-5D shows about a 6% improvement which is very small. I would have thought at best they could argue that CBT helps people cope and manage better. It makes it very hard for them to claim their hypothesis that ME is a behavioral disorder. In this paper they are clear about this hyposthesis:

    I don't see how they can argue that a therapy involving multiple different aspects with such poor results can back their theory. The same goes for the deconditioning theory and GET.

    If they really believed in their hypothesis they would have tested their version of CBT against a more standard version helping people cope.
     
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  16. Esther12

    Esther12 Senior Member

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  17. Esther12

    Esther12 Senior Member

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    At this point, I find it hard not to believe that they're actively corrupt, or else believe that the therapy just wasn't delivered properly as part of the RCT so they're justified in spinning the results (which is, I guess, just another way of being actively corrupt).

    They're results just look too much like homoeopathy to me.
     
  18. Dolphin

    Dolphin Senior Member

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    Except they didn't include benefits increases in the societal costs. I don't know how these things are normally calculated to know if benefits costs are usually included in societal cost calculations.
     
  19. alex3619

    alex3619 Senior Member

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    Another thing that has to be taken into account is lost productivity. If benefit claims went up, is it hard to suspect that productivity went down? Of course there is a delay in getting benefits, its also possible that the productivity of patients went down prior to getting benefits and the changes in benefits simply reflect this.

    So the main benefit is improved productivity in support workers, including family? You get the same benefit by simply abandoning the disabled. Were any measures taken to ensure that quality of care was not compromised? Or do they simply rely on patients ticking boxes that imply they are happier? Every time I increase my control over my circumstances I am happer. That is independent of my actual capacity to function.

    Bye, Alex
     
  20. Dolphin

    Dolphin Senior Member

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    Nice post, biophile.

    Extract:

    To put some figures on this: they estimated the healthcare cost of CBT as £904 and the healthcare cost of GET as £810. Given such low costs, one could see that it would not be hard to be cost-effective with self-report measures, especially in a mixed cohort (these are Oxford criteria patients).

    Of course, as has been said, there are also "costs", mainly in terms of their time and energy, for the participant in doing such courses. Loads of healthy people don't do regular exercise because it involves sacrifices; for people with M.E. or CFS who are already struggling, doing such a course, with all the homework, involves bigger sacrifices/is a serious commitment, especially for people with other responsibilities.
     
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