Two treatments found previously to be the most effective for patients with chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) have now been found to be the most cost-effective treatments evaluated in a large clinical trial.
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 findings are published in the journal PloS ONE.
The researchers drew their conclusions in line with healthcare cost criteria used by the National Institute for Health and Clinical Excellence. NICE 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 Michael Sharpe from Oxford University, who was involved in the research, 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.'
Lead author Professor Paul McCrone, a health economist from King's College London’s Institute of Psychiatry, added: '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.'
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.
The PACE trial was the largest ever randomised controlled trial of treatments for CFS/ME, and was co-ordinated by Que'n 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.
In 2011, the first findings from the PACE trial showed that CBT and GET benefit around 60% of patients with CFS/ME, for whom fatigue was the main symptom.
The latest study compared the cost-effectiveness of each treatment after one year against the criteria used by 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.
The PACE trial was funded by the MRC, National Institute for Health Research, Chief Scientist Office, Scotland, and Department for Work and Pensions.