Cost-Utility of a Psychoeducational Intervention in Fibromyalgia Patients Compared With Usual Care: An Economic Evaluation Alongside a 12-Month Randomized Controlled Trial.
– Source: The Clinical Journal of Pain, January 16, 2013
By J.V. Luciano, et al.
OBJECTIVE: To determine the effectiveness of adding psychoeducational treatment implemented in general practice to usual care for patients with fibromyalgia (FM), and to analyze the cost-utility of the intervention from health care and societal perspectives.
METHODS: Twelve-month randomized controlled trial. A total of 216 primary care patients meeting the American College of Rheumatology criteria for FM participated in the study. The intervention included 9, 2-hour sessions of psychoeducation (5 sessions of education about the illness+4 sessions of autogenic relaxation) added to usual care provided by a multidisciplinary group in general practice was compared to usual care in the public health system.
RESULTS: At 12-month follow-up, patients who received psychoeducation showed greater improvement in
global functional status (Cohen d=0.36; -2.49 to 3.81),
physical functioning (Cohen d=0.56; 0.08 to 1.00),
days feeling well (Cohen d=0.40; -0.16 to 1.02), pain (Cohen d= 0.35; -0.04 to 0.80),
morning fatigue (Cohen d=0.24; -0.20 to 0.76),
stiffness (Cohen d=0.34; -0.10 to 0.87),
and depression (Cohen d=0.30; -0.26 to 0.93).
Mean incremental cost per person receiving the intervention was &OV0556;-215.49 (-615.13 to 287.81) from the health care perspective, and &OV0556;-197.32 (-785.12 to 395.74) from the societal perspective. The incremental gain in quality-adjusted life-years per person was 0.12 (0.06 to 0.19), yielding a "dominant" intervention from both perspectives.
The sensitivity analysis suggested that the intervention was cost-effective even imputing all missing data.
DISCUSSION: Our findings demonstrate the long-term clinical effectiveness of a psychoeducational treatment program for FM implemented at primary care level and the cost-utility from a health care and societal perspective.
Source: The Clinical Journal of Pain, January 16, 2013. By J.V. Luciano, R. Sabes-Figuera, E. Cardenosa, M. T. Penarrubia-Maria, R. Fernandez-Fergel, J. Garcia-Campayo, M. Knapp, A. Serrano-Blanco. Research and Development Unit, Parc Sanitari Sant Joan de Déu., Sant Boi del Llobregat, Barcelona §Primary Health Centre Bartomeu Fabrés Anglada, DAP Baix Llobregat Litoral, Unitat Docent Costa de Ponent, Institut Català de la Salut., Gavà Department of Psychiatry, Miguel Servet Hospital, Aragon Institute of Health Sciences (I+CS), Zaragoza, Spain Primary Care Prevention and Health Promotion Research Network (RedIAPP, ISCIII, Madrid, Spain) Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, De Crespigny Park Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science (LSE), London, UK.