Cost-effectiveness of cognitive-behavioral group therapy for dysfunctional fear of progression in cancer patients.

Anxiety and fear are often associated with chronic conditions such as cancer. This paper targets the cost-effectiveness analysis of a cognitive-behavioral group therapy (CBT) in comparison to a client-centered, supportive-experiential group therapy (SET) in cancer patients with dysfunctional fear of progression. An incremental cost-effectiveness analysis was performed using data from a randomized controlled trial among cancer patients receiving inpatient rehabilitation. The means, 95% confidence intervals [95% CI], incremental cost-effectiveness graphic and acceptability curve were obtained from 1,000 bootstrap replications. A total of 174 patients were included in the economic evaluation. The estimated means [95% CI] of direct costs and reduction of fear of progression were 9,045.03 [6,359.07; 12,091.87] and 1.41 [0.93; 1.92] for patients in the SET and 6,682.78 [4,998.09; 8,440.95] and 1.44 [1.02; 1.09] for patients in the CBT. The incremental cost-effectiveness ratio [95% CI] amounts to minus 78,741.66 [-154,987.20; 110,486.32] for an additional unit of effect. Given the acceptability curve, there is a 92.4% chance that the CBT, compared with the SET, is cost-effective without the need of additional costs to payers. Our main result is the superior cost-effectiveness of the cognitive-behavioral intervention program in comparison to the non-directive encounter group for our sample of cancer patients with high levels of anxiety.

[Outcome sensitivity of the North American Spine Society Instrument with special consideration for the neurogenic symptoms of chronic back pain]. / Verlaufssensitivität des North American Spine Society Instrumentes unter besonderer Berücksichtigung der neurogenen Symptomatik bei chronischen Rückenbeschwerden.

BACKGROUND: Back pain is one of the most common chronic diseases in developed countries. The related enormous direct and indirect costs demand evidence-based decisions on rehabilitative care. Our study is intended to evaluate the two NASS outcome dimensions pain and neurological symptoms regarding their sensitivity to change within an inpatient rehabilitation scheme for chronic back pain. METHODS: The study observed a cohort of consecutive patients for one year (n = 70). By applying two outcomes instruments which are in common use internationally (SF-36 and NASS) it enhances comparability with other studies. Moreover the FFbH-R was applied for cross validation. RESULTS: On discharge from hospital an improvement of physical and emotional health as well as pain reduction were found. The results of the various instruments are consistent and support each other and suggest sensitivity to change of the NASS instrument regarding its pain and neurology subdimensions. CONCLUSION: The NASS outcome instrument monitors well the established therapeutic effects of chronic back pain inpatient rehabilitation schemes in the short run and in the long run over a twelve-month period following hospital discharge.