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(FINE Trial) Cost-effectiveness of supported self-management for CFS/ME patients in primary care

Discussion in 'Latest ME/CFS Research' started by Dolphin, Jan 20, 2013.

  1. Dolphin

    Dolphin Senior Member

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    http://www.biomedcentral.com/1471-2296/14/12/abstract
    Free: (Provisional) full text: http://www.biomedcentral.com/content/pdf/1471-2296-14-12.pdf
    *I've given each sentence its own paragraph
     
  2. Dolphin

    Dolphin Senior Member

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    A reminder what pragmatic rehabilitation is:
    One can read the initial presentation to patients in this thread:


    and the manual here:
    http://forums.phoenixrising.me/index.php?threads/fine-trial-pragmatic-rehabilitation-manual.21415/
     
  3. Dolphin

    Dolphin Senior Member

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    Minor:
    I think "myalgic encephalitis" is incorrect - should be "encephalomyelitis".

    -------
    Table 2 is interesting:
    "Cost of health care services and non-NHS expenditures related to CFS/ME at each follow up, by treatment group (mean, sd)*"

    PR does well in the lost earnings category in the first 20 weeks:
    Mean (SD): PR: 2601 (6460); Supportive listening: 4661 (15215); Treatment as usual: 3450 (7459).

    However, PR does really bad over weeks 44 to 70 in follow-up period
    Mean (SD): PR: 5562 (8776); Supportive listening: 3494 (8509); Treatment as usual: 3321 (5285).

    They don't make any comment on how bad PR did.
     
  4. Sasha

    Sasha Fine, thank you

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    UK
    Thanks for posting this, Dolphin. I must say I'm relieved to be spared the prospect of having some NHS-brainwashed nurse who has been profoundly and deliberately misinformed about ME 'supportively listen' to me or attempt to 'pragmatically rehabilitate' me.

    Small mercies. :D
     
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  5. Dolphin

    Dolphin Senior Member

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    Yes, although the form of CBT or GET generally offered by the NHS isn't a million miles away from pragmatic rehabilitation (a previous trial, Powell et al. 2001 has been included in systematic reviews for these) and CBT can be given by nurses.
     
    Sasha likes this.
  6. Dolphin

    Dolphin Senior Member

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    They just focused on NHS healthcare costs, which seems to be the main one in NICE calculations.

    The PACE Trial paper looked at healthcare costs but also separately did calculations for societal costs.


    Explanation of how the figures are used:

    ----
    They didn't compare the different methods directly with PACE: they first submitted the paper on August 16, 2012 while the McCrone PACE Trial paper was published on August 1, 2012 so perhaps this is excusable:

     
  7. Dolphin

    Dolphin Senior Member

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    There was a difference depending on whether they tried to impute missing values.
    When they imputed missing values (main analysis), Treatment as usual had slightly better QALYs


    However, if do a separate analysis when don't impute missing values:

    The underlined part means the difference was not statistically significant.
     
  8. Dolphin

    Dolphin Senior Member

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    If somebody had the time, I think it'd be good if one or more people responded to this with a comment.
    Basically, I think lots of patients would prefer other options to this one and also that their GPs weren't educated that this was a good approach.
     
  9. Dolphin

    Dolphin Senior Member

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    There is some data in the Appendix people could easily miss:

    There is an Appendix file at: http://www.biomedcentral.com/imedia/9227522608966898/supp1.docx

    The first eight pages of it look like they would not be of interest to the average patient - I haven't read them but they appear to be about how to deal with missing data.
    However, after that, the data is much more basic and comprehensible.

    We had some information on those topics from Table 2 in the main paper.

    However,
    and

    contain items "Time off work (days)" and "Leisure time lost (hours)".
    However, unfortunately they don't also include mean figures for these which would have made them more interesting I think.


    contains the exact EQ5D scores (so one doesn't have to estimate them from the figure)

    The appendix also has this little discussion:


    £3221 doesn't match £3321 in the main table 2.

    Those are my comments for the moment.
     
  10. Sean

    Sean Senior Member

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    If no current treatment option is satisfactory and acceptable, then why single out 'treatment as usual' in primary care?

    It should be:

    'However, dissatisfaction with current treatment options means simply continuing on with any of these options is unlikely to be acceptable to patients and practitioners.'
     

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