Esther12
Senior Member
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- 13,774
Compared to the PACE cost effectiveness paper, costs for CBT have risen a bit (PACE was done a few years ago... inflation, etc ), but the cost of assessment (SMC?) really seems a lot higher. One problem with PACE is that it was done in a way which made it very difficult to conclude that patients should just be left alone, as there wasn't any deliberately worthless placebo control, only the minimal intervention of SMC (which seemed to be little more than diagnosis, but could be used as a further justification for their specialist centres). [Edit: Actually, they use contemporary data for any cost savings made, so surely they should use contemporary data for the costs of treatment too?]
From PACE
https://www.national.slam.nhs.uk/wp...National-Services-Directory-2012-13_FINAL.pdf
Page 39
40
Location: Maudsley Hospital
Mode: Outpatient, outreach
Chronic Fatigue Service
including treatment for fatigue in the context of chronic diseases
Criteria
Eligibility
• 18+ years
• Male or female
• Long lasting physical or mental fatigue which has not responded to usual treatment (three months or more)
• Profound disability where the fatigue symptoms are impacting on all areas of the person’s life
• People who frequently attend the GP surgery and are not responding to usual reassurance and advice
• Disturbed sleep pattern, e.g. the person is sleeping during the day or unable to get to sleep at night and has not responded
to the usual treatment
Interventions which may be provided
Outcomes
• A specialist diagnostic clinical assessment
• Routine blood tests
• Appropriate referral to other specialists if necessary
• Specialist CBT
• Graded exercise therapy
• Guided self-help programme prior to face-to-face intervention
• Resume daily activities
• Establish sleep routine
• Address associated anxiety or depression
• Challenge problematic beliefs which interfere with progress,
which may relate to the rehabilitation programme,
perfectionism or low self-esteem
• Lifestyle changes which may help to prevent relapse
• A graded return to work, addressing long-term sickness issues
• A discharge plan incorporating a relapse plan
Between 50% and 75% of our
patients have seen an improvement
in terms of fatigue and physical
functioning, which can result in
returning to work following long-
term absences.
Our service is an internationally recognised research and
treatment unit, which provides a specialist diagnostic
assessment and treatment for people with chronic fatigue
syndrome (CFS). We have developed models for understanding
and treating CFS and continue to be at the forefront of
research and development in this field.
57% of our patients said they were
very much better, or much better at
the end of treatment.*
* Quarmby et al 2007; Behaviour Research and Therapy, 1085-1094
[Here's the paper, it's about how CBT does less well in routine practice than RCTs http://www.kcl.ac.uk/innovation/groups/projects/cfs/publications/assets/2007/Quarmbyrandomised.pdf ]
Our service has evolved in collaboration with patient
organisations. Our evidence-based treatments are routinely
evaluated. Our goal is to increase the person’s functioning,
improve quality of life and well-being, reduce the severity
of their fatigue and facilitate a return to work or education.
We pride ourselves in our ability to engage with people who
have complex and sometimes long-standing difficulties. Our
treatment is time limited, focuses on recovery and aims to
help patients develop skills and feel empowered to manage
their problems independently.
Our service also offers treatment for fatigue in the context
of chronic diseases, and for those with medically unexplained
symptoms like fibromyalgia and irritable bowel syndrome.
We provide a family-based service for adolescents and a home-
based treatment for those of all ages who are housebound.
Care option
Description
Cost
Unit
Code
Outpatient
Assessment
A two-hour diagnostic assessment with a psychiatrist, where a full
medical history is taken as well as a mental state assessment.
A physical examination may take place and any current investigations
may be reviewed. A diagnostic report is sent to the referrer and
includes a recommended treatment plan.
£739
Per assessment
321
Treatment,
CFS
Treatment involves 20 sessions of CBT or graded exercise therapy with
a psychotherapist or physiotherapist, to help people become less
functionally impaired and less fatigued by the end of their treatment.
People are offered follow-up appointments at three-monthly
intervals after the completion of treatment, for up to 12 months.
£176
Per session
91532
Treatment, CBT for
chronic conditions
CBT treatment with a psychotherapist or psychologist for fatigue
associated with chronic conditions, e.g. cancer, diabetes mellitus,
HIV, multiple sclerosis and rheumatoid arthritis. Recommended for
up to 20 sessions.
£176
Per session
92676
Medical review
One-hour review by the medical team, which may be needed if
medication needs to be prescribed or reviewed, or if the person’s
condition deteriorates. Also available as a second opinion for
occupational health requirements.
£193
Per review
92675
Outreach
Housebound
assessment and
treatment
Assessment and treatment as per the standard options, but in the
person’s home.
£966
£503
Per assessment
Per session
92627
91542
Referrals are accepted from:
Contacts:
Address:
Consultant psychiatrists
Community mental health
teams
GP consortia
GPs
Professor Trudie Chalder, Director
Dr Alastair Santhouse, Consultant Psychiatrist
Professor Simon Wessely, Consultant Psychiatrist
Suzanne Roche, Service Lead
Chronic Fatigue Service
Mapother House
Maudsley Hospital
Denmark Hill
London SE5 8AZ
Tel: 020 3228 5075
Fax: 020 3228 5074
Email: suzanne.roche@slam.nhs.uk
From PACE
Service Use and Costs
In our analysis we adopted both a healthcare and a societal perspective. (The latter includes lost employment and unpaid informal care as well as health costs.) The number and duration of APT, CBT, GET and SMC treatment sessions actually delivered were recorded and time added for preparation, related correspondence, and supervision. It was assumed that the ratio of time spent on patient-related versus support activities was 1:0.3 and that capital and administrative overheads were 46% [12]. The cost per hour of therapy was £110 for CBT and £100 for APT and GET. The cost of SMC was based on the cost per hour of consultant physician time in face-to-face contact with patients, which was £169 [12].
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0040808There was no clear difference between treatments in terms of lost employment.
https://www.national.slam.nhs.uk/wp...National-Services-Directory-2012-13_FINAL.pdf
Page 39
40
Location: Maudsley Hospital
Mode: Outpatient, outreach
Chronic Fatigue Service
including treatment for fatigue in the context of chronic diseases
Criteria
Eligibility
• 18+ years
• Male or female
• Long lasting physical or mental fatigue which has not responded to usual treatment (three months or more)
• Profound disability where the fatigue symptoms are impacting on all areas of the person’s life
• People who frequently attend the GP surgery and are not responding to usual reassurance and advice
• Disturbed sleep pattern, e.g. the person is sleeping during the day or unable to get to sleep at night and has not responded
to the usual treatment
Interventions which may be provided
Outcomes
• A specialist diagnostic clinical assessment
• Routine blood tests
• Appropriate referral to other specialists if necessary
• Specialist CBT
• Graded exercise therapy
• Guided self-help programme prior to face-to-face intervention
• Resume daily activities
• Establish sleep routine
• Address associated anxiety or depression
• Challenge problematic beliefs which interfere with progress,
which may relate to the rehabilitation programme,
perfectionism or low self-esteem
• Lifestyle changes which may help to prevent relapse
• A graded return to work, addressing long-term sickness issues
• A discharge plan incorporating a relapse plan
Between 50% and 75% of our
patients have seen an improvement
in terms of fatigue and physical
functioning, which can result in
returning to work following long-
term absences.
Our service is an internationally recognised research and
treatment unit, which provides a specialist diagnostic
assessment and treatment for people with chronic fatigue
syndrome (CFS). We have developed models for understanding
and treating CFS and continue to be at the forefront of
research and development in this field.
57% of our patients said they were
very much better, or much better at
the end of treatment.*
* Quarmby et al 2007; Behaviour Research and Therapy, 1085-1094
[Here's the paper, it's about how CBT does less well in routine practice than RCTs http://www.kcl.ac.uk/innovation/groups/projects/cfs/publications/assets/2007/Quarmbyrandomised.pdf ]
Our service has evolved in collaboration with patient
organisations. Our evidence-based treatments are routinely
evaluated. Our goal is to increase the person’s functioning,
improve quality of life and well-being, reduce the severity
of their fatigue and facilitate a return to work or education.
We pride ourselves in our ability to engage with people who
have complex and sometimes long-standing difficulties. Our
treatment is time limited, focuses on recovery and aims to
help patients develop skills and feel empowered to manage
their problems independently.
Our service also offers treatment for fatigue in the context
of chronic diseases, and for those with medically unexplained
symptoms like fibromyalgia and irritable bowel syndrome.
We provide a family-based service for adolescents and a home-
based treatment for those of all ages who are housebound.
Care option
Description
Cost
Unit
Code
Outpatient
Assessment
A two-hour diagnostic assessment with a psychiatrist, where a full
medical history is taken as well as a mental state assessment.
A physical examination may take place and any current investigations
may be reviewed. A diagnostic report is sent to the referrer and
includes a recommended treatment plan.
£739
Per assessment
321
Treatment,
CFS
Treatment involves 20 sessions of CBT or graded exercise therapy with
a psychotherapist or physiotherapist, to help people become less
functionally impaired and less fatigued by the end of their treatment.
People are offered follow-up appointments at three-monthly
intervals after the completion of treatment, for up to 12 months.
£176
Per session
91532
Treatment, CBT for
chronic conditions
CBT treatment with a psychotherapist or psychologist for fatigue
associated with chronic conditions, e.g. cancer, diabetes mellitus,
HIV, multiple sclerosis and rheumatoid arthritis. Recommended for
up to 20 sessions.
£176
Per session
92676
Medical review
One-hour review by the medical team, which may be needed if
medication needs to be prescribed or reviewed, or if the person’s
condition deteriorates. Also available as a second opinion for
occupational health requirements.
£193
Per review
92675
Outreach
Housebound
assessment and
treatment
Assessment and treatment as per the standard options, but in the
person’s home.
£966
£503
Per assessment
Per session
92627
91542
Referrals are accepted from:
Contacts:
Address:
Consultant psychiatrists
Community mental health
teams
GP consortia
GPs
Professor Trudie Chalder, Director
Dr Alastair Santhouse, Consultant Psychiatrist
Professor Simon Wessely, Consultant Psychiatrist
Suzanne Roche, Service Lead
Chronic Fatigue Service
Mapother House
Maudsley Hospital
Denmark Hill
London SE5 8AZ
Tel: 020 3228 5075
Fax: 020 3228 5074
Email: suzanne.roche@slam.nhs.uk
Last edited: