Adaptive Pacing, Cognitive Behaviour Therapy, Graded Exercise, and Specialist Medical Care for Chronic Fatigue Syndrome: A Cost-Effectiveness Analysis
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{"title"=>"Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: A cost-effectiveness analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Paul", "last_name"=>"McCrone", "scopus_author_id"=>"7003937597"}, {"first_name"=>"Michael", "last_name"=>"Sharpe", "scopus_author_id"=>"55669000100"}, {"first_name"=>"Trudie", "last_name"=>"Chalder", "scopus_author_id"=>"55396153200"}, {"first_name"=>"Martin", "last_name"=>"Knapp", "scopus_author_id"=>"7202388606"}, {"first_name"=>"Anthony L.", "last_name"=>"Johnson", "scopus_author_id"=>"7410016800"}, {"first_name"=>"Kimberley A.", "last_name"=>"Goldsmith", "scopus_author_id"=>"16174924600"}, {"first_name"=>"Peter D.", "last_name"=>"White", "scopus_author_id"=>"55924316400"}], "year"=>2012, "source"=>"PLoS ONE", "identifiers"=>{"pui"=>"365367069", "sgr"=>"84864775861", "pmid"=>"22870204", "scopus"=>"2-s2.0-84864775861", "isbn"=>"ES:1932-6203 IL:1932-6203", "doi"=>"10.1371/journal.pone.0040808", "issn"=>"19326203"}, "id"=>"09b73bba-56f6-30cf-8d69-ced4eed28d89", "abstract"=>"BACKGROUND: The PACE trial compared the effectiveness of adding adaptive pacing therapy (APT), cognitive behaviour therapy (CBT), or graded exercise therapy (GET), to specialist medical care (SMC) for patients with chronic fatigue syndrome. This paper reports the relative cost-effectiveness of these treatments in terms of quality adjusted life years (QALYs) and improvements in fatigue and physical function.\\n\\nMETHODS: Resource use was measured and costs calculated. Healthcare and societal costs (healthcare plus lost production and unpaid informal care) were combined with QALYs gained, and changes in fatigue and disability; incremental cost-effectiveness ratios (ICERs) were computed.\\n\\nRESULTS: SMC patients had significantly lower healthcare costs than those receiving APT, CBT and GET. If society is willing to value a QALY at £30,000 there is a 62.7% likelihood that CBT is the most cost-effective therapy, a 26.8% likelihood that GET is most cost effective, 2.6% that APT is most cost-effective and 7.9% that SMC alone is most cost-effective. Compared to SMC alone, the incremental healthcare cost per QALY was £18,374 for CBT, £23,615 for GET and £55,235 for APT. From a societal perspective CBT has a 59.5% likelihood of being the most cost-effective, GET 34.8%, APT 0.2% and SMC alone 5.5%. CBT and GET dominated SMC, while APT had a cost per QALY of £127,047. ICERs using reductions in fatigue and disability as outcomes largely mirrored these findings.\\n\\nCONCLUSIONS: Comparing the four treatments using a health care perspective, CBT had the greatest probability of being the most cost-effective followed by GET. APT had a lower probability of being the most cost-effective option than SMC alone. The relative cost-effectiveness was even greater from a societal perspective as additional cost savings due to reduced need for informal care were likely.", "link"=>"http://www.mendeley.com/research/adaptive-pacing-cognitive-behaviour-therapy-graded-exercise-specialist-medical-care-chronic-fatigue-5", "reader_count"=>32, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Professor > Associate Professor"=>3, "Librarian"=>3, "Researcher"=>4, "Student > Ph. D. Student"=>2, "Student > Postgraduate"=>4, "Student > Master"=>7, "Other"=>3, "Student > Bachelor"=>3, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Professor > Associate Professor"=>3, "Librarian"=>3, "Researcher"=>4, "Student > Ph. D. Student"=>2, "Student > Postgraduate"=>4, "Student > Master"=>7, "Other"=>3, "Student > Bachelor"=>3, "Professor"=>1}, "reader_count_by_subject_area"=>{"Engineering"=>1, "Unspecified"=>3, "Nursing and Health Professions"=>1, "Medicine and Dentistry"=>11, "Agricultural and Biological Sciences"=>2, "Sports and Recreations"=>2, "Psychology"=>5, "Social Sciences"=>1, "Computer Science"=>1, "Immunology and Microbiology"=>2, "Economics, Econometrics and Finance"=>3}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>11}, "Social Sciences"=>{"Social Sciences"=>1}, "Sports and Recreations"=>{"Sports and Recreations"=>2}, "Psychology"=>{"Psychology"=>5}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>3}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>2}, "Computer Science"=>{"Computer Science"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Unspecified"=>{"Unspecified"=>3}}, "reader_count_by_country"=>{"United States"=>1, "United Kingdom"=>2}, "group_count"=>3}

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  • {"files"=>["https://ndownloader.figshare.com/files/598816"], "description"=>"a<p>Percentage point difference between groups.</p><p>QALY  =  quality-adjusted life year, ICER  =  incremental cost-effectiveness ratio,</p><p>APT  =  adaptive pacing therapy, CBT  =  cognitive behaviour therapy, GET  =  graded exercise therapy, SMC  =  specialist medical care alone.</p>", "links"=>[], "tags"=>["healthcare", "societal"], "article_id"=>269312, "categories"=>["Ecology", "Medicine", "Mental Health", "Biotechnology"], "users"=>["Paul McCrone", "Michael Sharpe", "Trudie Chalder", "Martin Knapp", "Anthony L. Johnson", "Kimberley A. Goldsmith", "Peter D. White"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0040808.t006", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cost_effectiveness_results_from_healthcare_and_societal_perspectives_0_8211_52_weeks_/269312", "title"=>"Cost-effectiveness results from healthcare and societal perspectives, 0–52 weeks.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-01 02:35:12"}
  • {"files"=>["https://ndownloader.figshare.com/files/598925"], "description"=>"a<p>see <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0040808#pone.0040808.s001\" target=\"_blank\">Appendix S1</a> for servpone.0040808.g003.tifices included in these categories;</p>b<p>therapy and SMC costs are for 640 participants.</p><p>APT  =  adaptive pacing therapy, CBT  =  cognitive behaviour therapy, GET  =  graded exercise therapy, SMC  =  specialist medical care alone.</p>", "links"=>[], "tags"=>["costs", "baseline"], "article_id"=>269410, "categories"=>["Ecology", "Medicine", "Mental Health", "Biotechnology"], "users"=>["Paul McCrone", "Michael Sharpe", "Trudie Chalder", "Martin Knapp", "Anthony L. Johnson", "Kimberley A. Goldsmith", "Peter D. White"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0040808.t003", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Service_costs_at_baseline_and_follow_up_/269410", "title"=>"Service costs at baseline and follow-up.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-01 02:36:50"}
  • {"files"=>["https://ndownloader.figshare.com/files/598578"], "description"=>"<p>QALY-based cost-effectiveness acceptability curves (healthcare perspective).</p>", "links"=>[], "tags"=>["cost-effectiveness", "acceptability", "curves"], "article_id"=>269061, "categories"=>["Ecology", "Medicine", "Mental Health", "Biotechnology"], "users"=>["Paul McCrone", "Michael Sharpe", "Trudie Chalder", "Martin Knapp", "Anthony L. Johnson", "Kimberley A. Goldsmith", "Peter D. White"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0040808.g001", "stats"=>{"downloads"=>2, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_QALY_based_cost_effectiveness_acceptability_curves_healthcare_perspective_/269061", "title"=>"QALY-based cost-effectiveness acceptability curves (healthcare perspective).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-08-01 02:31:01"}
  • {"files"=>["https://ndownloader.figshare.com/files/598862"], "description"=>"<p>Data are N (%) unless otherwise stated.</p><p>APT  =  adaptive pacing therapy, CBT  =  cognitive behaviour therapy, GET  =  graded exercise therapy, SMC  =  specialist medical care alone, ME  =  myalgic encephalomyelitis, BMI  =  body mass index.</p>", "links"=>[], "tags"=>["public health and epidemiology", "Mental health", "rheumatology", "Non-clinical medicine"], "article_id"=>269351, "categories"=>["Ecology", "Medicine", "Mental Health", "Biotechnology"], "users"=>["Paul McCrone", "Michael Sharpe", "Trudie Chalder", "Martin Knapp", "Anthony L. Johnson", "Kimberley A. Goldsmith", "Peter D. White"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0040808.t001", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Baseline_demographic_and_clinical_data_/269351", "title"=>"Baseline demographic and clinical data.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-01 02:35:51"}
  • {"files"=>["https://ndownloader.figshare.com/files/598740"], "description"=>"<p>APT  =  adaptive pacing therapy, CBT  =  cognitive behaviour therapy, GET  =  graded exercise therapy, SMC  =  specialist medical care alone.</p>", "links"=>[], "tags"=>["receiving", "benefits"], "article_id"=>269230, "categories"=>["Ecology", "Medicine", "Mental Health", "Biotechnology"], "users"=>["Paul McCrone", "Michael Sharpe", "Trudie Chalder", "Martin Knapp", "Anthony L. Johnson", "Kimberley A. Goldsmith", "Peter D. White"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0040808.t004", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_N_receiving_welfare_benefits_or_other_financial_payments_/269230", "title"=>"N (%) receiving welfare benefits or other financial payments.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-01 02:33:50"}
  • {"files"=>["https://ndownloader.figshare.com/files/598783"], "description"=>"<p>APT  =  adaptive pacing therapy, CBT  =  cognitive behaviour therapy, GET  =  graded exercise therapy, SMC  =  specialist medical care alone.</p>", "links"=>[], "tags"=>["utilities", "qalys", "accrued", "follow-up"], "article_id"=>269270, "categories"=>["Ecology", "Medicine", "Mental Health", "Biotechnology"], "users"=>["Paul McCrone", "Michael Sharpe", "Trudie Chalder", "Martin Knapp", "Anthony L. Johnson", "Kimberley A. Goldsmith", "Peter D. White"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0040808.t005", "stats"=>{"downloads"=>3, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_EQ_5D_utilities_and_QALYs_accrued_during_follow_up_period_/269270", "title"=>"EQ-5D utilities and QALYs accrued during follow-up period.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-01 02:34:30"}
  • {"files"=>["https://ndownloader.figshare.com/files/313461"], "description"=>"<div><h3>Background</h3><p>The PACE trial compared the effectiveness of adding adaptive pacing therapy (APT), cognitive behaviour therapy (CBT), or graded exercise therapy (GET), to specialist medical care (SMC) for patients with chronic fatigue syndrome. This paper reports the relative cost-effectiveness of these treatments in terms of quality adjusted life years (QALYs) and improvements in fatigue and physical function.</p> <h3>Methods</h3><p>Resource use was measured and costs calculated. Healthcare and societal costs (healthcare plus lost production and unpaid informal care) were combined with QALYs gained, and changes in fatigue and disability; incremental cost-effectiveness ratios (ICERs) were computed.</p> <h3>Results</h3><p>SMC patients had significantly lower healthcare costs than those receiving APT, CBT and GET. If society is willing to value a QALY at £30,000 there is a 62.7% likelihood that CBT is the most cost-effective therapy, a 26.8% likelihood that GET is most cost effective, 2.6% that APT is most cost-effective and 7.9% that SMC alone is most cost-effective. Compared to SMC alone, the incremental healthcare cost per QALY was £18,374 for CBT, £23,615 for GET and £55,235 for APT. From a societal perspective CBT has a 59.5% likelihood of being the most cost-effective, GET 34.8%, APT 0.2% and SMC alone 5.5%. CBT and GET dominated SMC, while APT had a cost per QALY of £127,047. ICERs using reductions in fatigue and disability as outcomes largely mirrored these findings.</p> <h3>Conclusions</h3><p>Comparing the four treatments using a health care perspective, CBT had the greatest probability of being the most cost-effective followed by GET. APT had a lower probability of being the most cost-effective option than SMC alone. The relative cost-effectiveness was even greater from a societal perspective as additional cost savings due to reduced need for informal care were likely.</p> </div>", "links"=>[], "tags"=>["adaptive", "behaviour", "graded", "cost-effectiveness"], "article_id"=>121829, "categories"=>["Ecology", "Medicine", "Mental Health", "Biotechnology"], "users"=>["Paul McCrone", "Michael Sharpe", "Trudie Chalder", "Martin Knapp", "Anthony L. Johnson", "Kimberley A. Goldsmith", "Peter D. White"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0040808", "stats"=>{"downloads"=>5, "page_views"=>20, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Adaptive_Pacing_Cognitive_Behaviour_Therapy_Graded_Exercise_and_Specialist_Medical_Care_for_Chronic_Fatigue_Syndrome_A_Cost_Effectiveness_Analysis/121829", "title"=>"Adaptive Pacing, Cognitive Behaviour Therapy, Graded Exercise, and Specialist Medical Care for Chronic Fatigue Syndrome: A Cost-Effectiveness Analysis", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-01 00:30:29"}
  • {"files"=>["https://ndownloader.figshare.com/files/598894"], "description"=>"a<p>see <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0040808#pone.0040808.s001\" target=\"_blank\">Appendix S1</a> for services included in these categories,</p>b<p>contacts measured in bed days,</p>c<p>quantity unreported as average cost assumed for each patient using medication,</p>d<p>contacts measured in weekly hours,</p>e<p>days lost from work.</p><p>APT  =  adaptive pacing therapy, CBT  =  cognitive behaviour therapy, GET  =  graded exercise therapy, SMC  =  specialist medical care alone.</p>", "links"=>[], "tags"=>["baseline"], "article_id"=>269381, "categories"=>["Ecology", "Medicine", "Mental Health", "Biotechnology"], "users"=>["Paul McCrone", "Michael Sharpe", "Trudie Chalder", "Martin Knapp", "Anthony L. Johnson", "Kimberley A. Goldsmith", "Peter D. White"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0040808.t002", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Service_use_and_lost_employment_at_baseline_and_follow_up_/269381", "title"=>"Service use and lost employment at baseline and follow-up.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-01 02:36:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/598634"], "description"=>"<p>QALY-based cost-effectiveness acceptability curves (societal perspective).</p>", "links"=>[], "tags"=>["cost-effectiveness", "acceptability", "curves"], "article_id"=>269119, "categories"=>["Ecology", "Medicine", "Mental Health", "Biotechnology"], "users"=>["Paul McCrone", "Michael Sharpe", "Trudie Chalder", "Martin Knapp", "Anthony L. Johnson", "Kimberley A. Goldsmith", "Peter D. White"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0040808.g002", "stats"=>{"downloads"=>3, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_QALY_based_cost_effectiveness_acceptability_curves_societal_perspective_/269119", "title"=>"QALY-based cost-effectiveness acceptability curves (societal perspective).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-08-01 02:31:59"}

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Relative Metric

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