Guided graded exercise self-help for chronic fatigue syndrome: Long term follow up and cost-effectiveness following the GETSET trial
Guided graded exercise self-help for chronic fatigue syndrome: Long term follow up and cost-effectiveness following the GETSET trial
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DOI：
10.1016/j.jpsychores.2021.110484
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发表时间：
2021-04-22
影响因子：
4.7
通讯作者：
White，Peter D.
中科院分区：
文献类型：
--
作者：
Clark，Lucy;McCrone，Paul;White，Peter D.
GETSET试验发现，在随机分组12周后，指导分级运动自助（GES）比单独的专科医疗护理（SMC）更能改善慢性疲劳综合征（CFS）成人的疲劳和身体功能。在本文中，我们评估长期的临床和健康经济outcomes.MethodsGETSET是一项随机对照试验，211英国二级保健CFS患者。主要结果是Chalder疲劳问卷和短表36调查的身体功能子量表。在随机化后12个月，邮寄问卷评估了干预的主要结果和成本效益。服务成本和质量调整生命年（QHMS）相结合的成本效益analysis.ResultsBetween 2014年1月和2016年3月，164（78%）参与者返回问卷调查15个月后随机化。结果显示，干预臂对疲劳（chi2（1）= 4.8，p = 0.03）或身体功能（chi2（1）= 1.3，p = 0.25）没有主要影响，调整了多重性。其他干预组或时间组效应均不显著。对于被分配到GES的参与者，短期疲劳减轻在长期随访中得以维持，SMC后从短期到长期随访的疲劳有所改善，因此各组不再存在差异。GES的医疗保健成本高出85英镑，并产生了更多的QDLS。增量成本效益比为£4802每QALY.ConclusionsThe短期改善后，GES保持在长期随访，进一步改善SMC组，使各组不再不同，在长期随访。与单独SMC相比，GES的每QALY成本低于通常的阈值，表明具有成本效益，但结果存在不确定性。
ObjectiveThe GETSET trial found that guided graded exercise self-help (GES) improved fatigue and physical functioning more than specialist medical care (SMC) alone in adults with chronic fatigue syndrome (CFS) 12 weeks after randomisation. In this paper, we assess the longer-term clinical and health economic outcomes.MethodsGETSET was a randomised controlled trial of 211 UK secondary care patients with CFS. Primary outcomes were the Chalder fatigue questionnaire and the physical functioning subscale of the short-form-36 survey. Postal questionnaires assessed the primary outcomes and cost-effectiveness of the intervention 12 months after randomisation. Service costs and quality-adjusted life years (QALYs) were combined in a cost-effectiveness analysis.ResultsBetween January 2014 and March 2016, 164 (78%) participants returned questionnaires 15 months after randomisation. Results showed no main effect of intervention arm on fatigue (chi2(1) = 4.8,p= 0.03) or physical functioning (chi2(1) = 1.3,p= 0.25), adjusting for multiplicity. No other intervention arm or time*arm effect was significant. The short-term fatigue reduction was maintained at long-term follow-up for participants assigned to GES, with improved fatigue from short- to long-term follow up after SMC, such that the groups no longer differed. Healthcare costs were £85 higher for GES and produced more QALYs. The incremental cost-effectiveness ratio was £4802 per QALY.ConclusionsThe short-term improvements after GES were maintained at long-term follow-up, with further improvement in the SMC group such that the groups no longer differed at long-term follow-up. The cost per QALY for GES compared to SMC alone was below the usual threshold indicating cost-effectiveness, but with uncertainty around the result.