Cost-effectiveness of an extended-role [GP] clinic for [PPS]: results from the Multiple Symptoms Study 3 (MSS3)... 2024 Deary, Burton et al

Full title: Cost-effectiveness of an extended-role general practitioner clinic for persistent physical symptoms: results from the Multiple Symptoms Study 3 (MSS3) pragmatic randomised controlled trial

Highlights

• Persistent physical symptoms is a common problem, impacting patients’ quality of life with substantial costs to health services and society.
• This is the first economic evaluation to assess the value added by an extended-role GP symptoms clinic (SC) compared to UC in primary care.
• SC+UC has the potential to be cost-effective compared to UC alone in a 12 month time horizon, yielding increased QALYs at reasonable cost using a threshold £20 000 per QALY gained.

ABSTRACT

Objectives
To evaluate the cost-effectiveness of an extended-role general practitioner (GP) symptoms clinic (SC), added to usual care (UC) for patients with multiple persistent physical symptoms (sometimes known as "medically unexplained symptoms").

Methods
A 52-week within-trial cost-utility analysis of a pragmatic multicentre randomised controlled trial comparing SC+UC (n=178) against UC alone (n=176), conducted from the primary perspective of the UK National Health Service (NHS) and personal and social services (PSS). Base-case quality-adjusted life-years (QALYs) were measured using EQ-5D-5L. Missing data were imputed using multiple imputation (MI). Cost-effectiveness results were presented as incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits (INMBs). Uncertainty was explored using cost-effectiveness acceptability curves (using 1000 non-parametric bootstrapped samples) and sensitivity analysis (including societal costs, using SF-6D and capability ICECAP-A outcomes to estimate QALYs and years of full capability (YFC) respectively, varying intervention costs, missing data mechanism assumptions).

Results
Multiple imputation analysis showed that, compared to UC alone, SC+UC was more expensive [(adjusted mean cost difference: 704; 95% CI:£605, £807)] and more effective [(adjusted mean QALY difference: 0.0447 (95% CI:0.0067, 0.0826)] yielding an ICER of £15,765/QALY, INMB of £189.22 (95% CI:−£573.62, £948.28) and a 69% probability of the SC+UC intervention arm being cost-effective at a threshold of £20000 per QALY. Results were robust to most sensitivity analyses, but sensitive to missing data assumptions (2 of the 8 scenarios investigated), SF-6D and ICECAP-A quality of life outcomes.

Conclusions
A Symptoms Clinic is likely to be a potentially cost-effective treatment for patients with persistent physical symptoms.

Open access, https://www.sciencedirect.com/science/article/pii/S1098301524066452

 

Likely to potentially...improve quality of life (debatably measured) and somewhat save some money somewhere but not much money and the money that was maybe saved in secondary care (which is all that really matters to NHSE and ICSs) was probably due to chance anyway.

 

So the same old nothing. The idea that this is effective, even cost-effective, is laughable. But almost no one seems bothered by that.

"Illness without disease". As they explain early on, this is what they perceive as 'somatization'. So, the exact same old nonsense with the same intent and purpose, the same methods and models.

Literally the same old nonsense, basically in the form of a GP consult, but longer, then offering 'explanations' about things they don't understand:

And as is tradition, the difference is not statistically significant, but they still think that even though it's more expensive, that it must be cost-effective and recommend it:

Mathematicians and physicists work with imaginary numbers, but physicians deal with really imaginary numbers. Well, that and lies, damned lies, and statistical analyses of really imaginary numbers.

And what is a clinic, if not a 'symptoms clinic'? Of course they mean symptoms with no physical cause they understand, which they prefer to think of as 'somatization'. Hey, this approach has failed for decades, maybe this time doing it exactly the same old way it will work*.

And of course this is a randomized trial but they call it randomized controlled because why not? It's not as if anyone cares about stuff like this anymore.

(* It won't)

 

What a minute, this was done during Covid, and they didn’t factor that into the analysis of subsequent resource use.

 

Indeed

I saw this and thought of the phrase ‘playing the system’

and of course it’s these HCPs who are wanting to profit by knowing where the sales pitches are (not the patients getting immorally screwed over by this)

it never saves money

always makes patients worse and leads to numbers increasing and then the cheek is they use that failure as an excuse to say they need more money to do the same crap ‘because the issue is growing’

someone needs to get wise and regulate this pathway to conning ICBs full of busy people being smarmed and the tick boxes being played in a way reminiscent of the days of drug reps when they were allowed to give gifts or kickbacks or whatever it was

how are these people any different to that other than they are playing the money train from the inside?

 

It's mentioned in the text but they mostly shrug it off as "good enough", even though given that those were a small number of assigned GPs I don't think this excuse holds up well (6 GPs were involved, come on) but I doubt it would have changed anything and it's not as if any of this matters, trials like this always write themselves from the conclusion out. They are funded not to provide information but to make evidence up for that conclusion:

 

Gonna (presumably, if accurate) quote Gandhi here: "Methodological and ethical standards in psychosomatics? I think it would be a good idea".

 

I didn't bother calculating what it means but when you put it like that it's not just completely laughable, as you say this is about years/days of perfect health so it's not even valid since those are healthy years equivalent. It literally means nothing. This is at least as completely delusional as homeopathy, probably even more.