RESUMO
BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) imposes a substantial societal and economic burden. The aim of this study is to ascertain the optimal level of public research and development (R&D) investment in Germany for a prospective drug, given the pressing need for effective treatments. METHODS: This study calculates the societal value from a German perspective by integrating health and economic outcomes in the context of public R&D investment for ME/CFS. It considers factors such as direct medical costs, productivity loss, and the effectiveness of a prospective drug. RESULTS: The anticipated introduction of a prospective drug is estimated to yield a quality-adjusted life year (QALY) gain of approximately 29,000 and a societal value of about 2.6 billion. The optimal R&D investment in Germany is estimated at 676 million, which represents about a quarter of the total investment required to bring a significant drug to market, considering diminishing returns and market constraints. Results were confirmed in the sensitivity analysis. CONCLUSIONS: The study concludes that a coordinated international approach is imperative to address the funding and market size limitations effectively in developing treatments for ME/CFS and to realize the substantial societal and economic benefits.
Assuntos
Síndrome de Fadiga Crônica , Anos de Vida Ajustados por Qualidade de Vida , Alemanha , Humanos , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/tratamento farmacológico , Análise Custo-Benefício , Estudos Prospectivos , Efeitos Psicossociais da DoençaRESUMO
BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating, chronic, multisystem disease that affects an estimated 1 to 2.5 million Americans. It has no widely accepted biomarkers and no FDA-approved treatment. ME/CFS has traditionally been one of the lowest funded diseases by the United States National Institutes of Health (NIH). OBJECTIVES: We provide here an update to our 2016 article, which estimated the disease burden of ME/CFS in the United States in 2013 and its relation to NIH's 2015 analysis of research funding and disease burden. This update incorporates more recent burden data from 2015 and funding data from 2017. METHODS: We perform a regression analysis on funding versus disease burden to determine 2017 funding levels that would be commensurate with burden. Burden figures for 2017 are estimated using population-based extrapolations of earlier data. RESULTS: We find the disease burden of ME/CFS is double that of HIV/AIDS and over half that of breast cancer. We also find that ME/CFS is more underfunded with respect to burden than any disease in NIH's analysis of funding and disease burden, with ME/CFS receiving roughly 7% of that commensurate with disease burden. CONCLUSIONS: To be commensurate with disease burden, NIH funding would need to increase roughly 14-fold.
Assuntos
Financiamento de Capital/normas , Efeitos Psicossociais da Doença , Síndrome de Fadiga Crônica/complicações , Pesquisa/economia , Financiamento de Capital/estatística & dados numéricos , Síndrome de Fadiga Crônica/economia , Humanos , Pesquisa/estatística & dados numéricos , Estados UnidosRESUMO
The FITNET-NHS Trial is a UK, national, trial investigating whether an online cognitive behavioural therapy program (FITNET-NHS) for treating chronic fatigue syndrome/ME in adolescents is clinically effective and cost-effective in the NHS. At the time of writing (September 2019), the trial was recruiting participants. This article presents an update to the planned sample size and data collection duration previously published within the trial protocol. TRIAL REGISTRATION: ISRCTN, ID: 18020851. Registered 8 April 2016.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Análise Custo-Benefício , Síndrome de Fadiga Crônica/terapia , Intervenção Baseada em Internet/economia , Adolescente , Criança , Terapia Cognitivo-Comportamental/economia , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/economia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Tamanho da Amostra , Medicina Estatal/economia , Resultado do Tratamento , Reino UnidoRESUMO
BACKGROUND: Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health and Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as a treatment option for paediatric CFS/ME because there is good evidence that it is effective. Despite this, most young people in the UK are unable to access local specialist CBT for CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective in the Netherlands but we do not know if it is effective in the National Health Service (NHS) or if it is cost-effective. This trial will investigate whether FITNET-NHS is clinically effective and cost-effective in the NHS. METHODS: Seven hundred and thirty-four paediatric patients (aged 11-17 years) with CFS/ ME will be randomised (1:1) to receive either FITNET-NHS (online CBT) or Activity Management (delivered via video call). The internal pilot study will use integrated qualitative methods to examine the feasibility of recruitment and the acceptability of treatment. The full trial will assess whether FITNET-NHS is clinically effective and cost-effective. The primary outcome is disability at 6 months, measured using the SF-36-PFS (Physical Function Scale) questionnaire. Cost-effectiveness is measured via cost-utility analysis from an NHS perspective. Secondary subgroup analysis will investigate the effectiveness of FITNET-NHS in those with co-morbid mood disorders. DISCUSSION: If FITNET-NHS is found to be feasible and acceptable (internal pilot) and effective and cost-effective (full trial), its provision by the NHS has the potential to deliver substantial health gains for the large number of young people suffering from CFS/ME but unable to access treatment because there is no local specialist service. This trial will provide further evidence evaluating the delivery of online CBT to young people with chronic conditions. TRIAL REGISTRATION: ISRCTN registry, registration number: ISRCTN18020851 . Registered on 4 August 2016.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Atenção à Saúde , Síndrome de Fadiga Crônica/terapia , Internet , Medicina Estatal , Terapia Assistida por Computador/métodos , Adolescente , Comportamento do Adolescente , Afeto , Fatores Etários , Criança , Comportamento Infantil , Terapia Cognitivo-Comportamental/economia , Análise Custo-Benefício , Atenção à Saúde/economia , Avaliação da Deficiência , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/psicologia , Estudos de Viabilidade , Feminino , Custos de Cuidados de Saúde , Humanos , Internet/economia , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Transtornos do Humor/terapia , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto , Medicina Estatal/economia , Terapia Assistida por Computador/economia , Fatores de Tempo , Resultado do Tratamento , Reino UnidoRESUMO
OBJECTIVE: Investigate the effectiveness and cost-effectiveness of the Lightning Process (LP) in addition to specialist medical care (SMC) compared with SMC alone, for children with chronic fatigue syndrome (CFS)/myalgic encephalitis (ME). DESIGN: Pragmatic randomised controlled open trial. Participants were randomly assigned to SMC or SMC+LP. Randomisation was minimised by age and gender. SETTING: Specialist paediatric CFS/ME service. PATIENTS: 12-18 year olds with mild/moderate CFS/ME. MAIN OUTCOME MEASURES: The primary outcome was the the 36-Item Short-Form Health Survey Physical Function Subscale (SF-36-PFS) at 6 months. Secondary outcomes included pain, anxiety, depression, school attendance and cost-effectiveness from a health service perspective at 3, 6 and 12 months. RESULTS: We recruited 100 participants, of whom 51 were randomised to SMC+LP. Data from 81 participants were analysed at 6 months. Physical function (SF-36-PFS) was better in those allocated SMC+LP (adjusted difference in means 12.5(95% CI 4.5 to 20.5), p=0.003) and this improved further at 12 months (15.1 (5.8 to 24.4), p=0.002). At 6 months, fatigue and anxiety were reduced, and at 12 months, fatigue, anxiety, depression and school attendance had improved in the SMC+LP arm. Results were similar following multiple imputation. SMC+LP was probably more cost-effective in the multiple imputation dataset (difference in means in net monetary benefit at 12 months £1474(95% CI £111 to £2836), p=0.034) but not for complete cases. CONCLUSION: The LP is effective and is probably cost-effective when provided in addition to SMC for mild/moderately affected adolescents with CFS/ME. TRIAL REGISTRATION NUMBER: ISRCTN81456207.
Assuntos
Síndrome de Fadiga Crônica/terapia , Psicoterapia de Grupo , Adolescente , Protocolos Clínicos , Terapia Combinada , Análise Custo-Benefício , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/psicologia , Síndrome de Fadiga Crônica/reabilitação , Feminino , Humanos , Masculino , Psicoterapia de Grupo/economia , Resultado do TratamentoAssuntos
Pesquisa Biomédica/economia , Síndrome de Fadiga Crônica , National Institutes of Health (U.S.)/economia , Orçamentos , Congressos como Assunto , Síndrome de Fadiga Crônica/tratamento farmacológico , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/etiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Rituximab/uso terapêutico , Estados UnidosRESUMO
Unexplained fatigue is not infrequent in the community. It presents a number of challenges to the primary care physician and particularly if the clinical examination and routine investigations are normal. However, while fatigue is a feature of many common illnesses, it is the main problem in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This is a poorly understood condition that is accompanied by several additional symptoms which suggest a subtle multisystem dysfunction. Not infrequently it is complicated by sleep disturbance and alterations in attention, memory and mood.Specialised services for the diagnosis and management of CFS/ME are markedly deficient in the UK and indeed in virtually all countries around the world. However, unexplained fatigue and CFS/ME may be confidently diagnosed on the basis of specific clinical criteria combined with the normality of routine blood tests. The latter include those that assess inflammation, autoimmunity, endocrine dysfunction and gluten sensitivity. Early diagnosis and intervention in general practice will do much to reduce patient anxiety, encourage improvement and prevent expensive unnecessary investigations.There is presently an on-going debate as to the precise criteria that best confirms CFS/ME to the exclusion of other medical and psychiatric/psychological causes of chronic fatigue. There is also some disagreement as to best means of investigating and managing this very challenging condition. Uncertainty here can contribute to patient stress which in some individuals can perpetuate and aggravate symptoms. A simple clinical scoring system and a short list of routine investigations should help discriminate CFS/ME from other causes of continued fatigue.
Assuntos
Depressão/psicologia , Síndrome de Fadiga Crônica/diagnóstico , Fadiga/etiologia , Medicina Geral/métodos , Ansiedade/psicologia , Diagnóstico Diferencial , Fadiga/economia , Síndrome de Fadiga Crônica/complicações , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/terapia , Custos de Cuidados de Saúde , Humanos , Avaliação de SintomasAssuntos
Acessibilidade aos Serviços de Saúde/economia , Mucopolissacaridose III/enfermagem , Programas Nacionais de Saúde/economia , Doenças Raras/enfermagem , Pré-Escolar , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/enfermagem , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Mucopolissacaridose III/economia , Doenças Raras/economia , SuíçaRESUMO
BACKGROUND: Fatigue is a common yet difficult to treat condition in primary care. The objective of this study is to evaluate the cost-effectiveness of a brief cognitive behavioral therapy (CBT) based fatigue self-management (FSM) intervention as compared to usual care among patients with chronic fatigue in primary care. METHODS: An economic evaluation alongside of a parallel randomized controlled study design was used. Computer-generated variable-sized block randomization plan was used to assign patients into treatment groups and data collection staff were blinded to group assignments. Patients aged between 18 and 65 years with at least six months of persistent fatigue and no medical or psychiatric exclusions were enrolled from a large primary care practice in Stony Brook, New York. The FSM group (n = 37) received two sessions of a nurse-delivered, fatigue self-management protocol and a self-help book and the usual care group (n = 36) received regular medical care. The effectiveness measure was the Fatigue Severity Scale and the cost measure was total health care expenditures derived from monthly health services use diaries during follow-up. A societal perspective was adopted and bootstrapped incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) were calculated as measures of cost-effectiveness. RESULTS: The ICER for FSM was -$$2358, indicating that FSM dominates UC and it may generate societal cost savings as compared to usual care. Complete case analysis yielded smaller ICER (-$1199) with greater uncertainties. Net monetary benefit analysis showed that FSM has a probability of 0.833 (95% CI: 0.819, 0.847) to achieve positive NMB and the favorable results were not sensitive to assumptions about informal care or treatment costs. CONCLUSION: This economic evaluation found initial evidence that a two-session brief CBT-based FSM may be cost-effective as compared to usual care over 12 months. The FSM intervention is potentially a promising intervention for chronic fatigue patients in primary care. Additional research is needed to examine the reproducibility and generalizability of these findings. TRIAL REGISTRATION: ClinicalTrials.gov (NCT00997451, March 28, 2009).
Assuntos
Terapia Cognitivo-Comportamental/economia , Síndrome de Fadiga Crônica/economia , Serviços de Saúde/economia , Autocuidado/economia , Adolescente , Adulto , Idoso , Terapia Cognitivo-Comportamental/métodos , Análise Custo-Benefício , Síndrome de Fadiga Crônica/terapia , Feminino , Custos de Cuidados de Saúde , Gastos em Saúde , Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Autocuidado/métodos , Adulto JovemRESUMO
BACKGROUND: Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and potentially serious condition with a limited evidence base for treatment. Specialist treatment for paediatric CFS/ME uses interventions recommended by National Institute for Health and Clinical Excellence (NICE) including cognitive behavioural therapy, graded exercise therapy and activity management. The Lightning Process (LP) is a trademarked intervention derived from osteopathy, life-coaching and neuro-linguistic programming, delivered over three consecutive days as group sessions. Although over 250 children with CFS/ME attend LP courses each year, there are no reported studies on the effectiveness or cost-effectiveness. METHODS: This pragmatic randomised controlled trial is set within a specialist paediatric CFS/ME service in the south west of England. Children and young people with CFS/ME (n = 80 to 112), aged 12 to 18 years old will be randomised to specialist medical care (SMC) or SMC plus the LP. The primary outcome will be physical function (SF-36 physical function short form) and fatigue (Chalder Fatigue Scale). DISCUSSION: This study will tell us whether adding the LP to SMC is effective and cost-effective compared to SMC alone. This study will also provide detailed information on the implementation of the LP and SMC. TRIAL REGISTRATION: Current Controlled Trials ISRCTN81456207 (31 July 2012).
Assuntos
Síndrome de Fadiga Crônica/terapia , Psicoterapia de Grupo , Projetos de Pesquisa , Adolescente , Criança , Protocolos Clínicos , Terapia Combinada , Análise Custo-Benefício , Inglaterra , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/fisiopatologia , Síndrome de Fadiga Crônica/psicologia , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Psicoterapia de Grupo/economia , Inquéritos e Questionários , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Nurse led self-help treatments for people with chronic fatigue syndrome/myalgic encephalitis (CFS/ME) have been shown to be effective in reducing fatigue but their cost-effectiveness is unknown. METHODS: Cost-effectiveness analysis conducted alongside a single blind randomised controlled trial comparing pragmatic rehabilitation (PR) and supportive listening (SL) delivered by primary care nurses, and treatment as usual (TAU) delivered by the general practitioner (GP) in North West England. A within trial analysis was conducted comparing the costs and quality adjusted life years (QALYs) measured within the time frame of the trial. 296 patients aged 18 and over with CFS/ME diagnosed using the Oxford criteria were included in the cost-effectiveness analysis. RESULTS: Treatment as usual is less expensive and leads to better patient outcomes compared with Supportive Listening. Treatment as usual is also less expensive than Pragmatic Rehabilitation. PR was effective at reducing fatigue in the short term, but the impact of the intervention on QALYs was uncertain. However, based on the results of this trial, PR is unlikely to be cost-effective in this patient population. CONCLUSIONS: This analysis does not support the introduction of SL. Any benefits generated by PR are unlikely to be of sufficient magnitude to warrant recommending PR for this patient group on cost-effectiveness grounds alone. However, dissatisfaction with current treatment options means simply continuing with 'treatment as usual' in primary care is unlikely to be acceptable to patients and practitioners. TRIAL REGISTRATION: The trial registration number is IRCTN74156610.
Assuntos
Aconselhamento/economia , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/terapia , Padrões de Prática em Enfermagem , Atenção Primária à Saúde/economia , Autocuidado/economia , Atividades Cotidianas , Adulto , Análise de Variância , Análise Custo-Benefício , Inglaterra , Síndrome de Fadiga Crônica/reabilitação , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Método Simples-Cego , Sono , Resultado do Tratamento , Adulto JovemRESUMO
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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Assuntos
Terapia Cognitivo-Comportamental/economia , Terapia por Exercício/economia , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/terapia , Adulto , Terapia Cognitivo-Comportamental/métodos , Custos e Análise de Custo , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reino UnidoRESUMO
BACKGROUND: Patients with chronic fatigue syndrome experience extreme fatigue, which often leads to substantial limitations of occupational, educational, social and personal activities. Currently, there is no consensus regarding the treatment. Patients try many different therapies to overcome their fatigue. Although there is no consensus, cognitive behavioural therapy is seen as one of the most effective treatments. Little is known about multidisciplinary rehabilitation treatment, a combination of cognitive behavioural therapy with principles of mindfulness, gradual increase of activities, body awareness therapy and pacing. The difference in effectiveness and cost-effectiveness between multidisciplinary rehabilitation treatment and cognitive behavioural therapy is as yet unknown. The FatiGo (Fatigue-Go) trial aims to compare the effects of both treatment approaches in outpatient rehabilitation on fatigue severity and quality of life in patients with chronic fatigue syndrome. METHODS: One hundred twenty patients who meet the criteria of chronic fatigue syndrome, fulfil the inclusion criteria and sign the informed consent form will be recruited. Both treatments take 6 months to complete. The outcome will be assessed at 6 and 12 months after the start of treatment. Two weeks after the start of treatment, expectancy and credibility will be measured, and patients will be asked to write down their personal goals and score their current performance on these goals on a visual analogue scale. At 6 and 14 weeks after the start of treatment, the primary outcome and three potential mediators-self-efficacy, causal attributions and present-centred attention-awareness-will be measured. Primary outcomes are fatigue severity and quality of life. Secondary outcomes are physical activity, psychological symptoms, self-efficacy, causal attributions, impact of disease on emotional and physical functioning, present-centred attention-awareness, life satisfaction, patient personal goals, self-rated improvement and economic costs. The primary analysis will be based on intention to treat, and longitudinal analysis of covariance will be used to compare treatments. DISCUSSION: The results of the trial will provide information on the effects of cognitive behavioural therapy and multidisciplinary rehabilitation treatment at 6 and 12 months follow-up, mediators of the outcome, cost-effectiveness, cost-utility, and the influence of treatment expectancy and credibility on the effectiveness of both treatments in patients with chronic fatigue syndrome. TRIAL REGISTRATION: Current Controlled Trials ISRCTN77567702.
Assuntos
Terapia Cognitivo-Comportamental , Síndrome de Fadiga Crônica/terapia , Equipe de Assistência ao Paciente , Projetos de Pesquisa , Atenção , Conscientização , Terapia Cognitivo-Comportamental/economia , Terapia Combinada , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Emoções , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/psicologia , Síndrome de Fadiga Crônica/reabilitação , Custos de Cuidados de Saúde , Humanos , Países Baixos , Equipe de Assistência ao Paciente/economia , Qualidade de Vida , Centros de Reabilitação , Autoeficácia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Paediatric chronic fatigue syndrome or myalgic encephalopathy (CFS/ME) is relatively common and children can be severely affected attending little or no school for extended periods. There are no studies quantifying the financial impact of having a child with CFS/ME and there is little information of the impact on parental mood. METHODS: Forty mothers of children with CFS/ME from a regional specialist CFS/ME service completed inventories to assess their psychological well-being (Hospital Anxiety and Depression Scale, General Health Questionnaire-12) loss of earnings and increased expenditure. In addition, eight mothers took part in a semi-structured qualitative interview. RESULTS: Most parents of children with CFS/ME experience loss of monthly income (mean = £247) and increase in monthly expenditure (mean = £206). Twenty-eight (72%) mothers were above the cut-off for the General Health Questionnaire-12 compared with 20% in the healthy population (95% CI 55, 85, P < 0.001) suggesting they probably have a mental health problem. This may be explained by the qualitative interviews where mothers described five areas contributing to poor parental health: lack of understanding from others; marital tension; concern about their child's distress; concern about the impact on siblings and emotional distress causing physical symptoms. CONCLUSIONS: The majority of families of children with CFS/ME experience decreased income and increased expenditure with a marked impact on maternal psychological health. Clinicians need to be aware of this to provide appropriate support to families who care for children with CFS/ME.
Assuntos
Efeitos Psicossociais da Doença , Síndrome de Fadiga Crônica/economia , Mães/psicologia , Adolescente , Atitude Frente a Saúde , Criança , Pré-Escolar , Inglaterra , Saúde da Família , Síndrome de Fadiga Crônica/psicologia , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Masculino , Transtornos Mentais/etiologia , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Apoio Social , Estresse Psicológico/etiologia , Adulto JovemRESUMO
BACKGROUND: Few studies have investigated factors associated with discontinuation of employment in patients with CFS/ME or quantified its impact on productivity. METHODS: We used patient-level data from five NHS CFS/ME services during the period 01/04/2006-31/03/2010 collated in the UK CFS/ME National Outcomes Database. We used logistic regression to identify factors associated with discontinuation of employment. We estimated UK-wide productivity costs using patient-level data on duration of illness before assessment by a CFS/ME service, duration of unemployment, age, sex and numbers of patients, in conjunction with Office for National Statistics income and population data. RESULTS: Data were available for 2,170 patients, of whom 1,669 (76.9%) were women. Current employment status was recorded for 1,991 patients (91.8%), of whom 811 patients (40.7%) were currently employed and 998 (50.1%) had discontinued their employment "because of fatigue-related symptoms". Older age, male sex, disability, fatigue, pain, and duration of illness were associated with cessation of employment. In a multivariable model, age, male sex, and disability remained as independent predictors. Total productivity costs among the 2,170 patients due to discontinuation of employment in the years preceding assessment by a specialist CFS/ME service (median duration of illness=36 months) were £49.2 million. Our sample was equivalent to 4,424 UK adults accessing specialist services each year, representing productivity costs to the UK economy of £102.2 million. Sensitivity analyses suggested a range between £75.5-£128.9 million. CONCLUSIONS: CFS/ME incurs huge productivity costs amongst the small fraction of adults with CFS/ME who access specialist services.
Assuntos
Absenteísmo , Emprego/estatística & dados numéricos , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/terapia , Adulto , Distribuição de Qui-Quadrado , Intervalos de Confiança , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Estudos Transversais , Bases de Dados Factuais , Pessoas com Deficiência/reabilitação , Pessoas com Deficiência/estatística & dados numéricos , Eficiência , Emprego/economia , Síndrome de Fadiga Crônica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reino UnidoRESUMO
BACKGROUND: Nearly 1 in 10 in the population experience fatigue of more than six months at any one time. Chronic fatigue is a common reason for consulting a general practitioner, and some patients report their symptoms are not taken seriously enough. A gap in perceptions may occur because doctors underestimate the impact of fatigue on patients' lives. The main aim of the study is to explore the economic impact of chronic fatigue in patients seeking help from general practitioners and to identify characteristics that explain variations in costs. METHODS: The design of study was a survey of patients presenting to general practitioners with unexplained chronic fatigue. The setting were 29 general practice surgeries located in the London and South Thames regions of the English National Health Service. Use of services over a six month period was measured and lost employment recorded. Regression models were used to identify factors that explained variations in these costs. RESULTS: The mean total cost of services and lost employment across the sample of 222 patients was 3878 pounds for the six-month period. Formal services accounted for 13% of this figure, while lost employment accounted for 61% and informal care for 26%. The variation in the total costs was significantly related to factors linked to the severity of the condition and social functioning. CONCLUSIONS: The economic costs generated by chronic fatigue are high and mostly borne by patients and their families. Enquiry about the functional consequences of fatigue on the social and occupational lives of patients may help doctors understand the impact of fatigue, and make patients feel better understood.
Assuntos
Efeitos Psicossociais da Doença , Família/psicologia , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/psicologia , Medicina Geral/economia , Custos de Cuidados de Saúde , Absenteísmo , Emprego/economia , Inglaterra , Síndrome de Fadiga Crônica/diagnóstico , Humanos , Modelos Logísticos , Programas Nacionais de SaúdeAssuntos
Cristianismo , Síndrome de Fadiga Crônica , Pessoas sem Cobertura de Seguro de Saúde , Adaptação Psicológica , Adulto , Cristianismo/psicologia , Síndrome de Fadiga Crônica/economia , Síndrome de Fadiga Crônica/psicologia , Síndrome de Fadiga Crônica/reabilitação , Financiamento Pessoal , Humanos , Pessoas sem Cobertura de Seguro de Saúde/psicologiaRESUMO
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.