A Dutch study has shown there are high costs associated with multidisciplinary (MD) intervention and aerobic exercise (AE) for fibromyalgia (FM).1 Based on these results and an earlier analysis of the same patient cohort showing limited health benefits from these 2 approaches,2 the researchers believe they are not cost-effective in routine use.
“Given the absence of beneficial health effects but additional high intervention costs of MD and AE, such interventions cannot be recommended to all patients with FM,” wrote principal investigator Yvonne van Eijk-Hustings, RN, PhD, and her coinvestigators. “Notwithstanding, we cannot exclude that a subgroup of patients might have benefit from MD or AE; an appropriate selection of patients for intervention may result in larger effects and may contribute to cost-effectiveness.”
Dr van Eijk-Hustings, Senior Researcher and Rheumatology Nurse, Department of Patient & Care, Department of Rheumatology, Maastricht University Medical Centre, and her colleagues focused on 203 consecutive patients who had been recently diagnosed with FM at 3 medical centers in the Netherlands. Of these, 108 were randomized to MD, 47 to AE, and 48 to usual care (UC).
MD consisted of an initial 12-week group course (3 half-days/week) with two 1.5-hour therapy sessions per day; twice-weekly group sociotherapy and physiotherapy; and weekly group psychotherapy and creative-arts therapy. Then for 40 weeks there were 5 group sessions and up to 7 individual therapy sessions if the therapist and/or patient considered it necessary. AE involved a 12-week, twice-weekly group course led by a trained physiotherapist, following recommendations for exercise. The UC group comprised individualized FM education and lifestyle advice from a rheumatologist or rheumatology nurse, plus possible referral to additional therapies.
The earlier study had shown that, while there was significantly improved quality of life and overall health with MD compared with AE and UC, there were no significant between-group differences at 21- to 24-month follow-up.
In the new analysis, the total direct costs per person (in 2012 euros [US dollars]3) over the 2 years after diagnosis, including intervention costs, were €4252 (US $5256) for UC, €4321 (US $5341) for AE, and €4740 (US $5859) for MD. The between-group differences were not statistically significant.
Visits to general practitioners, specialists, physiotherapists, and other health professionals all were reduced in each group between when the patients were diagnosed and when they started the interventions. The use of formal help in the home in members of all 3 groups increased during the study.
The overall healthcare costs decreased after diagnosis but increased again between the start of the intervention and the end of the postintervention follow-up period.
“The important thing is that costs are high in all 3 groups and that after 2 years, between-group differences are too small to justify expensive interventions,” Dr van Eijk-Hustings told Value-Based Care in Rheumatology. “I think that different healthcare systems result in different costs, but I believe that an intensive intervention always will be more expensive. In the end you want to show that there is additional gain from spending extra costs, but we were not able to."
- Van Eijk-Hustings Y, Kroese M, Creemers A, et al. Resource utilisation and direct costs in patients with recently diagnosed fibromyalgia who are offered one of three different interventions in a randomised pragmatic trial [published online September 26, 2015]. Clin Rheumatol. doi:10.1007/s10067-015-3067-y.
- Van Eijk-Hustings Y, Kroese M, Tan F, et al. Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial. Clin Rheumatol. 2013;32:199-209.
- Yearly average currency exchange rates: translating foreign currency into U.S. dollars. IRS website. www.irs.gov/Individuals/International-Taxpayers/Yearly-Average-Currency-Exchange-Rates. Updated January 23, 2015. Accessed November 2, 2015.