Long-term economic evaluation of cognitive-behavioural group treatment versus enhanced usual care for functional somatic syndromes☆,☆☆
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 (17)
Internet-delivered treatment for patients suffering from severe functional somatic disorders: Protocol for a randomized controlled trial
2023, Contemporary Clinical Trials CommunicationsA step towards a new delimitation of functional somatic syndromes: A latent class analysis of symptoms in a population-based cohort study
2018, Journal of Psychosomatic ResearchCitation Excerpt :Functional somatic syndromes (FSS) such as fibromyalgia (FM), chronic fatigue syndrome (CFS) and irritable bowel syndrome (IBS) are associated with poor health status, increased health care use and high economic costs for the society [1,2].
Physical comorbidity in patients with multiple functional somatic syndromes. A register-based case-control study
2018, Journal of Psychosomatic ResearchCitation Excerpt :Patients with severe or multiple functional somatic syndromes such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome show markedly reduced functioning and health-related quality of life [1–4].
Is psychotherapy for functional somatic syndromes harmful? A mixed methods study on negative effects
2017, Journal of Psychosomatic ResearchCitation Excerpt :BDS covers a range of overlapping FSS and somatoform disorders [7]. These disorders are costly for the individual patient who risks long-term disease [8] and for society in terms of disability pension awards and health care expenditures [9,10]. Studies have shown that psychological treatment can alleviate FSS and increase physical functioning [1,6,11–14].
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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.
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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.