Zijlstra T R, Braakman-Jansen L M A, Taal E, Rasker J J, van de Laar M A F J
1Medisch Spectrum Twente Hospital, Department of Rheumatology, Enschede, The Netherlands.
Rheumatology (Oxford). 2007 Sep;46(9):1454-9. doi: 10.1093/rheumatology/kem157. Epub 2007 Jul 17.
To estimate the cost-effectiveness of an adjuvant treatment course of spa treatment compared with usual care only in patients with fibromyalgia syndrome (FM).
134 patients with FM, selected from a rheumatology outpatient department and from members of the Dutch FM patient association were randomly assigned to a 2(1/2) week spa treatment course in Tunisia or to usual care only. Results are expressed as quality-adjusted life years (QALYs) for a 6-month as well as a 12-month time horizon. Utilities were derived form the Short Form 6D (SF-6D) scores and the visual analogue scale (VAS) rating general health. Costs were reported from societal perspective. Mean incremental cost per patient and the incremental cost utility ratio (ICER) were calculated; 95% confidence intervals (CIs) were estimated using double-sided bootstrapping.
The data of 128 (55 spa and 73 controls) of the 134 patients (96%) could be used for analysis. Improvement in general health was found in the spa group until 6 months of follow-up by both the SF-6D (AUC 0.32 vs 0.30, P < 0.05) and the VAS (AUC 0.23 vs 0.19, P < 0.01). After 1yr no significant between-group differences were found. Mean incremental cost of spa treatment was 1311 Euro per patient (95% CI 369-2439), equalling the cost of the intervention (thalassotherapy including airfare and lodging), or 885 Euro per patient based on a more realistic cost estimate.
The temporary improvement in quality of life due to an adjuvant treatment course of spa therapy for patients with FM is associated with limited incremental costs per patient.
评估与仅接受常规护理相比，水疗辅助治疗疗程对纤维肌痛综合征（FM）患者的成本效益。
从风湿病门诊和荷兰FM患者协会成员中选取134例FM患者，随机分为两组，一组在突尼斯接受为期2（1/2）周的水疗疗程，另一组仅接受常规护理。结果以6个月和12个月时间范围内的质量调整生命年（QALYs）表示。效用值由简式6维健康量表（SF-6D）得分和视觉模拟量表（VAS）对总体健康状况的评分得出。成本从社会角度进行报告。计算每位患者的平均增量成本和增量成本效用比（ICER）；使用双侧自举法估计95%置信区间（CIs）。
134例患者中的128例（55例水疗组和73例对照组，96%）的数据可用于分析。在随访6个月时，水疗组的总体健康状况有所改善，SF-6D（AUC 0.32对0.30，P < 0.05）和VAS（AUC 0.23对0.19，P < 0.01）均显示如此。1年后，两组之间未发现显著差异。水疗治疗的平均增量成本为每位患者1311欧元（95% CI 369 - 2439），等同于干预成本（海水浴疗法，包括机票和住宿），或基于更实际成本估计的每位患者885欧元。
FM患者接受水疗辅助治疗疗程后生活质量的暂时改善与每位患者有限的增量成本相关。
