Long-term economic evaluation of cognitive-behavioural group treatment versus enhanced usual care for functional somatic syndromes,☆☆

https://doi.org/10.1016/j.jpsychores.2017.01.005Get rights and content

Highlights

  • STreSS had a very high likelihood to be cost-effective from a healthcare perspective.

  • Medium-term cost-effectiveness from a societal perspective was uncertain.

  • This may be due to higher indirect costs (i.e. sickness benefits) during treatment.

  • In the long-term, STreSS was associated with increasing cost savings.

  • Implementation may lead to substantial savings in public expenditures.

Abstract

Objective

Patients with functional somatic syndromes (FSS) such as fibromyalgia and chronic fatigue syndrome have a poor outcome and can incur high healthcare and societal costs. We aimed to compare the medium-term (16 months) cost-effectiveness and the long-term (40 months) economic outcomes of a bespoke cognitive-behavioural group treatment (STreSS) with that of enhanced usual care (EUC).

Methods

We obtained complete data on healthcare and indirect costs (i.e. labour marked-related and health-related benefits) from public registries for 120 participants from a randomised controlled trial. Costs were calculated as per capita public expenses in 2010 €. QALYs gained were estimated from the SF-6D. We conducted a medium-term cost-effectiveness analysis and a long-term cost-minimization analysis from both a healthcare (i.e. direct cost) and a societal (i.e. total cost) perspective.

Results

In the medium term, the probability that STreSS was cost-effective at thresholds of 25,000 to 35,000 € per QALY was 93–95% from a healthcare perspective, but only 50–55% from a societal perspective. In the long term, however, STreSS was associated with increasing savings in indirect costs, mainly due to a greater number of patients self-supporting. When combined with stable long-term reductions in healthcare expenditures, there were total cost savings of 7184 € (95% CI 2271 to 12,096, p = 0.004) during the third year after treatment.

Conclusion

STreSS treatment costs an average of 1545 €. This cost was more than offset by subsequent savings in direct and indirect costs. Implementation could both improve patient outcomes and reduce costs.

Section snippets

Background

Functional somatic syndromes (FSS) such as fibromyalgia, irritable bowel and chronic fatigue syndrome are a major public health issue. FSS are prevalent worldwide in all medical settings, and when severe pose a major burden on sufferers, health services, and on society. They incur considerable direct and even greater indirect costs [1], [2], [3], [4], [5], [6], [7]. The direct costs mainly reflect repeated referrals to secondary medical care in order to exclude physical disease [5], [8].

Study design and participants

The STreSS-1 trial (clinicaltrial.gov NCT00132197) was a two-arm, single-site, non-blinded, randomised controlled trial comparing a group CBT programme (STreSS) with usual care enhanced by a thorough clinical assessment (EUC) [20], [21]. The trial was conducted at Aarhus University Hospital, Denmark from 2005 to 2008 within a general hospital setting. Most patients were referred by their primary care physician. Referred patients were included in the trial if they fulfilled criteria for the

Sample characteristics

In the trial, 120 patients were randomised; 54 to STreSS and 66 to EUC. Table 1 presents demographic and clinical characteristics at baseline as well as use of healthcare and social welfare through the last year before randomisation. Groups were comparable on all measures including social benefits.

Healthcare costs

Average annual healthcare costs are presented in Table 2a. Costs were comparable between both groups in the year before randomisation (ASL = 0.209). During the 4-month treatment period, STreSS incurred

Discussion

This study compared the medium-term cost-effectiveness and long-term economic consequences of a group CBT programme (STreSS) for patients with a range of severe FSS with that of enhanced usual care (EUC). Our main findings were that STreSS had a high likelihood of being cost-effective from a medium-term healthcare perspective, and was associated with increasing savings in public expenses during long-term follow-up. To our knowledge, no previous studies have shown such clear, long-lasting

Acknowledgments

We thank Nicolai Kristensen from the governmental agency KORA in Copenhagen for advice regarding the calculation of indirect costs, Charlotte Ulrikka Rask and our colleagues from the Research Clinic for Functional Disorders for critical comments regarding the manuscript, and the patients for their participation in the STreSS-1 trial.

The trial21 was funded by Central Denmark Region, the Aarhus University Hospital Research Initiative, the A.P. Møller Foundation for the Advancement of Medical

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  • Cited by (0)

    Author contribution: AS, MS and PF are co-investigators of the STreSS-1 trial. AS, EØ and PF conceived and designed the study. AS and EØ obtained and combined data from public registries and calculated individual direct and indirect costs. EØ and JSJ conducted statistical analysis. AS drafted the paper. All authors participated in the interpretation of the findings, were involved in critically revising the paper and approved the final manuscript.

    ☆☆

    Conflict of interest: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf. The authors have no competing interests to report.

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