Simon
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GET QALY improvement not significantly better than SMC?
Fatigue & Function cost-effectiveness may be overstated
Re: Proportion on Benefit may go up due to time lag
Just as important, none of the interventions reduced benefit levels, which is hardly a ringing endorsement of said treatments.
This implies the GET QALY gains were not significantly different than for SMC, though table 6 does show a QALY gain of 0.034 for GET compard to SMC, which is a tad confusing.CBT produced the largest QALY gain, significantly more than SMC. After controlling for baseline utility, the difference between CBT and SMC was 0.05 (95% CI 0.01 to 0.09). No other differences between treatment groups were statistically significant.
Fatigue & Function cost-effectiveness may be overstated
This looks to me like they used the proportion who improved, while ignoring the proportion who worsened by the same amount (point © Dolphin), which could overstate the benefit (depends on proportions who worsened on CBT/GET vs SMC).ICER indicates the [cost per QALY gained or] cost per unit
reduction in fatigue or disability for one treatment against another...
ICERs constructed with the CFQ and SF-36 PF data used the
differences in proportions achieving clinically important changes.
Re: Proportion on Benefit may go up due to time lag
Although we don't know the outcome of this analysis, the SMC group has the shortest average illness duration so is a crude proxy of this. At baseline, SMC has the lowest proportion on illness/disability benefits but has caught up by 12 months (proportion increasing from 34% to 58%, Table 4). So this is consistent with the idea that the increases in proportion on benefits is reflecting a time lag in awarding benefits rather than a deteoriation in health - though clearly it isn't conclusive.A good point, particularly given that these patients hadn't been ill that long:
SMC: 25 months (25% less than 15 months)
CBT: 36 months (25% less than 16 months)
GET: 35 months (25% less than 18 months)
The authors could run analyses that would throw light on this: were people with a shorter illness duration more likely to be awarded benefits during the trial?
Just as important, none of the interventions reduced benefit levels, which is hardly a ringing endorsement of said treatments.