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Implementing cognitive behavior therapy for chronic fatigue syndrome in mental health care: a costs and outcomes analysis.

Scheeres K, Wensing M, Bleijenberg G, Severens JL - BMC Health Serv Res (2008)

Bottom Line: Bootstrap analyses were performed to estimate the uncertainty around the cost and outcome results. 125 CFS patients were included in the study.Costs of patients' health care and productivity losses had decreased significantly.The outcomes of this study might facilitate health care providers when confronted with the decision whether or not to adopt CBT for CFS in their institution.

View Article: PubMed Central - HTML - PubMed

Affiliation: Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre (4628), PO Box 9101, 6500 HB, The Netherlands. k.scheeres@nkcv.umcn.nl

ABSTRACT

Background: This study investigated the costs and outcomes of implementing cognitive behavior therapy (CBT) for chronic fatigue syndrome (CFS) in a mental health center (MHC). CBT is an evidence-based treatment for CFS that was scarcely available until now. To investigate the possibilities for wider implementation, a pilot implementation project was set up.

Method: Costs and effects were evaluated in a non-controlled before- and after study with an eight months time-horizon. Both the costs of performing the treatments and the costs of implementing the treatment program were included in the analysis. The implementation interventions included: informing general practitioners (GPs) and CFS patients, training therapists, and instructing the MHC employees. Given the non-controlled design, cost outcome ratios (CORs) and their acceptability curves were analyzed. Analyses were done from a health care perspective and from a societal perspective. Bootstrap analyses were performed to estimate the uncertainty around the cost and outcome results.

Results: 125 CFS patients were included in the study. After treatment 37% had recovered from CFS and the mean gained QALY was 0.03. Costs of patients' health care and productivity losses had decreased significantly. From the societal perspective the implementation led to cost savings and to higher health states for patients, indicating dominancy. From the health care perspective the implementation revealed overall costs of 5.320 euros per recovered patient, with an acceptability curve showing a 100% probability for a positive COR at a willingness to pay threshold of 6.500 euros per recovered patient.

Conclusion: Implementing CBT for CFS in a MHC appeared to have a favorable cost outcome ratio (COR) from a societal perspective. From a health care perspective the COR depended on how much a recovered CFS patient is being valued. The strength of the evidence was limited by the non-controlled design. The outcomes of this study might facilitate health care providers when confronted with the decision whether or not to adopt CBT for CFS in their institution.

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Related in: MedlinePlus

Patient flow.
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Figure 1: Patient flow.

Mentions: Figure 1 presents the patient flow. From the 143 patients that entered the MHC during the observation period, 18 'no show' patients never showed up at the intake session. Since they only caused negligible costs they were excluded from this study. The remaining 125 patients were included. At intake 13 patients appeared not to fulfil the diagnostic criteria for CFS, these patients did not start treatment. Of the 112 patients that started treatment, 28 dropped out of treatment quickly after the intake session. Of the 84 patients that followed treatment 12 dropped out half way or later and 72 finished treatment.


Implementing cognitive behavior therapy for chronic fatigue syndrome in mental health care: a costs and outcomes analysis.

Scheeres K, Wensing M, Bleijenberg G, Severens JL - BMC Health Serv Res (2008)

Patient flow.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2536664&req=5

Figure 1: Patient flow.
Mentions: Figure 1 presents the patient flow. From the 143 patients that entered the MHC during the observation period, 18 'no show' patients never showed up at the intake session. Since they only caused negligible costs they were excluded from this study. The remaining 125 patients were included. At intake 13 patients appeared not to fulfil the diagnostic criteria for CFS, these patients did not start treatment. Of the 112 patients that started treatment, 28 dropped out of treatment quickly after the intake session. Of the 84 patients that followed treatment 12 dropped out half way or later and 72 finished treatment.

Bottom Line: Bootstrap analyses were performed to estimate the uncertainty around the cost and outcome results. 125 CFS patients were included in the study.Costs of patients' health care and productivity losses had decreased significantly.The outcomes of this study might facilitate health care providers when confronted with the decision whether or not to adopt CBT for CFS in their institution.

View Article: PubMed Central - HTML - PubMed

Affiliation: Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre (4628), PO Box 9101, 6500 HB, The Netherlands. k.scheeres@nkcv.umcn.nl

ABSTRACT

Background: This study investigated the costs and outcomes of implementing cognitive behavior therapy (CBT) for chronic fatigue syndrome (CFS) in a mental health center (MHC). CBT is an evidence-based treatment for CFS that was scarcely available until now. To investigate the possibilities for wider implementation, a pilot implementation project was set up.

Method: Costs and effects were evaluated in a non-controlled before- and after study with an eight months time-horizon. Both the costs of performing the treatments and the costs of implementing the treatment program were included in the analysis. The implementation interventions included: informing general practitioners (GPs) and CFS patients, training therapists, and instructing the MHC employees. Given the non-controlled design, cost outcome ratios (CORs) and their acceptability curves were analyzed. Analyses were done from a health care perspective and from a societal perspective. Bootstrap analyses were performed to estimate the uncertainty around the cost and outcome results.

Results: 125 CFS patients were included in the study. After treatment 37% had recovered from CFS and the mean gained QALY was 0.03. Costs of patients' health care and productivity losses had decreased significantly. From the societal perspective the implementation led to cost savings and to higher health states for patients, indicating dominancy. From the health care perspective the implementation revealed overall costs of 5.320 euros per recovered patient, with an acceptability curve showing a 100% probability for a positive COR at a willingness to pay threshold of 6.500 euros per recovered patient.

Conclusion: Implementing CBT for CFS in a MHC appeared to have a favorable cost outcome ratio (COR) from a societal perspective. From a health care perspective the COR depended on how much a recovered CFS patient is being valued. The strength of the evidence was limited by the non-controlled design. The outcomes of this study might facilitate health care providers when confronted with the decision whether or not to adopt CBT for CFS in their institution.

Show MeSH
Related in: MedlinePlus