The latest results from the PACE trial show that both cognitive behaviour therapy (CBT) and graded exercise therapy (GET), as supplements to specialist medical care, offer good value for money for healthcare providers when the cost of treatment is weighed up against improvement in quality of life.
CBT and GET were found to be even more cost-effective when the savings to wider society – through a reduced need for additional care by family members – were taken into account. Adaptive pacing therapy (APT) was not cost-effective. The research was led by King’s College London, the University of Oxford and Queen Mary, University of London, and was funded by the Medical Research Council (MRC), National Institute for Health Research (NIHR) and UK government departments.
The researchers drew their conclusions in line with healthcare cost criteria used by NICE (National Institute for Health and Clinical Excellence), which considers treatments costing less than £20,000 to £30,000 per year lived in good health (known as a quality-adjusted life years, or QALYs) to represent value for money.
Professor Paul McCrone, a health economist from King’s College London’s Institute of Psychiatry and lead author of the paper, said:
“It’s very encouraging that two treatments found to help a significant number of CFS/ME patients are also cost-effective based on existing NICE criteria. There is now a strong case for the NHS to invest in providing these therapies. Our research suggests this investment would be justified in terms of improving quality of life for patients and could actually save costs to society if the impact on family members is taken into account.”
Professor Michael Sharpe from Oxford University and a co-author of the paper said:
“In the PACE trial we found that the rehabilitative treatments CBT and GET improve the fatigue and disability of people with CFS/ME. This new analysis of the trial data finds that these treatments are also cost-effective in improving patients’ quality of life. They are potentially cost-saving to society if the time of family and carers is also considered. This new evidence should encourage health service commissioners to provide these treatments to all those patients who need them.”
Professor David Lomas, Chair of the MRC Population and Systems Medicine Board, which co-funded the PACE trial, said:
“CFS/ME has a profound effect on patients and can severely impact their quality of life. These promising findings demonstrate how MRC funding can help to identify treatments that are not only effective, but are financially viable for the health service. There is still a pressing need to understand more about the underlying causes of CFS/ME and we recently announced a further £1.6m of funding for this purpose in the hope it will lead to new diagnostic tools and treatments.”
CFS/ME is a long-term, complex and debilitating condition that affects around 250,000 people in the UK, including children. Symptoms include profound physical and mental fatigue, muscle and joint pain, disturbed sleep patterns and concentration and memory problems. The combination and severity of symptoms varies from patient to patient, making it a difficult condition to diagnose and treat.
In 2011, the first findings from the PACE trial showed that CBT and GET benefit around 60 per cent of patients with CFS/ME, for whom fatigue was the main symptom. The latest study, published in the journal PLOS ONE, compared the cost-effectiveness of each treatment after one year against the criteria used by the NHS watchdog NICE. The researchers looked at the total cost of each course of treatment to the NHS and to wider society through patients requiring time off work and informal care from friends and relatives.
Specialist medical care was the cheapest option in terms of absolute cost to provide, but when the benefit of treatment on quality of life was taken into account, CBT became the most cost-effective option (likelihood of 62.7 per cent). There was a 26.8 per cent likelihood that GET was the most cost effective, while the likelihood for APT and standard care alone were 2.6 and 7.9 per cent, respectively.
The PACE trial was funded by the MRC, National Institute for Health Research, Chief Scientist Office, Scotland, and Department for Work and Pensions.
Notes to editors
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The paper, ‘Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: A cost-effectiveness analysis’, is published in the journal PloS ONE: http://dx.plos.org/10.1371/journal.pone.0040808
About the PACE trial
PACE is the largest ever randomised controlled trial of treatments for CFS/ME, co-ordinated by Queen Mary, University of London, the University of Oxford and King’s College London. It began in 2005 and compared four of the main treatments currently available for CFS/ME.
All 640 trial participants received specialist medical care, which included general advice about managing the illness and prescribed medicines for symptoms such as insomnia and pain.
Patients were randomly divided into four groups and three of the groups were also given one of the following therapies over six months:
- Cognitive behavioural therapy (CBT) – A clinical psychologist or specially trained nurse helps the patient to understand how their symptoms can be affected by the way that they think about and cope with them, and encourages them to try increasing their activity.
- Graded exercise therapy (GET) – A physiotherapist helps the patient to try a gradually increasing tailored exercise programme which takes into account the individual patient’s symptoms, fitness, and current level of activity.
- Adaptive pacing therapy (APT) – An occupational therapist helps the patient to match their activity level to the amount of energy they have, aiming to help the patient adapt to the illness rather than assuming they can gradually do more.
CBT and GET are used widely in the health service to treat a range of conditions including rheumatoid arthritis, heart disease, diabetes and chronic pain.
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The Chief Scientist Office (CSO) is the part of the Scottish Government Health and Social Care Directorates which supports and promotes high quality research aimed at improving the quality and cost-effectiveness of services offered by NHS Scotland and securing lasting improvements to the health of the people of Scotland. CSO supports research initiated by the research community in Scotland and advises the Scottish Government on how research contributes to improvements in health and healthcare. CSO’s research strategy “Investing in Research: Improving Health” sets out key aims for 2010-14 including giving greater emphasis to funding experimental and translational medicine research and health services and health population research. CSO also aims to deliver value for money through partnerships with other funding agencies and to foster Scotland-wide working through NHS Research Scotland (NRS) and Health Science Scotland.