08:36pm Saturday 11 July 2020

Two effective treatments for CFS/ME are also cost-effective

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

For more information please contact:

Hannah Isom

Senior Press Officer, Medical Research Council

T: 0207 395 2345 (out of hours: 07818 428 297)

E: [email protected]
 

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.

 

Additional quotes from the co-authors:

 

Professor Peter White, from Barts and The London School of Medicine and Dentistry, part of Queen Mary, University of London, a co-author of the paper, said:

 

“This is good news for patients and their families; for too long patients have been neglected by our health services. Now we all know that these therapies are not only effective for patients, but cost-effective for health services as well. The additional good news is that they also help to reduce the impact on families caring for their relatives.”

 

Professor Trudie Chalder, also from King’s College London’s Institute of Psychiatry and a co-author of the paper, said:

 

“In this period of austerity it is extremely encouraging that CBT and GET are cost-effective. It is now imperative that we encourage health professionals to deliver these effective treatments in established services across the country.”

 

1. For almost 100 years the Medical Research Council has improved the health of people in the UK and around the world by supporting the highest quality science. The MRC invests in world-class scientists. It has produced 29 Nobel Prize winners and sustains a flourishing environment for internationally recognised research. The MRC focuses on making an impact and provides the financial muscle and scientific expertise behind medical breakthroughs, including one of the first antibiotics penicillin, the structure of DNA and the lethal link between smoking and cancer. Today MRC funded scientists tackle research into the major health challenges of the 21st century. www.mrc.ac.uk

 

2. King’s College London is one of the top 30 universities in the world (2011/12 QS international world rankings), and was The Sunday Times ‘University of the Year 2010/11′, and the fourth oldest in England. A research-led university based in the heart of London, King’s has nearly 23,500 students (of whom more than 9,000 are graduate students) from nearly 140 countries, and some 6,000 employees. King’s is in the second phase of a £1 billion redevelopment programme which is transforming its estate. King’s has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £525 million (year ending 31 July 2011). King’s has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres. King’s College London and Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts are part of King’s Health Partners. King’s Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world’s leading research-led universities and three of London’s most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: www.kingshealthpartners.org. The College is in the midst of a five-year, £500 million fundraising campaign – World questions|King’s answers – created to address some of the most pressing challenges facing humanity as quickly as feasible. The campaign’s three priority areas are neuroscience and mental health, leadership and society, and cancer. More information about the campaign is available at www.kcl.ac.uk/kingsanswers.

 

3. Queen Mary, University of London is one of the UK’s leading research-focused higher education institutions with some 16,900 undergraduate and postgraduate students. Amongst the largest of the colleges of the University of London, Queen Mary is a member of the Russell Group, which represents the 24 leading universities in the UK. Queen Mary’s 3,800 staff deliver world class degree programmes and research across 21 academic departments and institutes, within three sectors: Science and Engineering; Humanities, Social Sciences and Laws; and the School of Medicine and Dentistry. Queen Mary is ranked 11th in the UK according to the Guardian analysis of the 2008 Research Assessment Exercise, and has been described as ‘the biggest star among the research-intensive institutions’ by the Times Higher Education. The College has a strong international reputation, with around 20 per cent of students coming from over 100 countries. Queen Mary has an annual turnover of £300 million, research income worth £70 million, and generates employment and output worth £600 million to the UK economy each year. The College is unique amongst London’s universities in being able to offer a completely integrated residential campus, with a 2,000-bed award-winning Student Village on its Mile End campus.

 

4. Oxford University’s Medical Sciences Division is one of the largest biomedical research centres in Europe, with over 2,500 people involved in research and more than 2,800 students. The University is rated the best in the world for medicine, and it is home to the UK’s top-ranked medical school. From the genetic and molecular basis of disease to the latest advances in neuroscience, Oxford is at the forefront of medical research. It has one of the largest clinical trial portfolios in the UK and great expertise in taking discoveries from the lab into the clinic. Partnerships with the local NHS Trusts enable patients to benefit from close links between medical research and healthcare delivery. A great strength of Oxford medicine is its long-standing network of clinical research units in Asia and Africa, enabling world-leading research on the most pressing global health challenges such as malaria, TB, HIV/AIDS and flu. Oxford is also renowned for its large-scale studies which examine the role of factors such as smoking, alcohol and diet on cancer, heart disease and other conditions.

 

The National Institute for Health Research (NIHR) is funded through the Department of Health to improve the health and wealth of the nation through research.  Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence, and systems represent the most integrated health research system in the world. http://www.nihr.ac.uk/

 

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.


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