***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Background : Fibromyalgia is a chronic condition associated with widespread pain , sleep disturbance and disability . Disease related costs are high and effective treatment options few . Objectives : To evaluate the cost effectiveness of pregabalin in the treatment of fibromyalgia . Methods : A decision-analytic model was developed comparing pregabalin 300 mg or 450 mg against placebo , duloxetine 60 mg or 120 mg , gabapentin , tramadol and amitriptyline . After a 12 week treatment phase patients who responded to treatment entered an ongoing treatment phase using a Markov model in which patients maintained response , lost response or dropped out . The base case considered patients with severe fibromyalgia defined as a Fibromyalgia Impact Question naire score of ≥59 and a pain score of ≥6.5 at baseline . Response rates for pregabalin and placebo were taken from three r and omised trials , and a 1 year open-label extension study was used for long-term parameters . Response was defined as a ≥30 % improvement over baseline in pain score and a patient global impression of change rating of much improved or very much improved . Relative rates of response for other comparators over placebo were extracted from a systematic review of published r and omised controlled studies . The primary effectiveness endpoint was Quality Adjusted Life Years ( QALYs ) . Utilities gained over baseline were estimated by applying the SF-6D utility algorithm to SF-36 data collected in the pregabalin trials . Re source use associated with fibromyalgia management was estimated from published studies and costs were estimated from the UK NHS perspective at 2008 prices . Costs and QALYs were discounted at 3.5 % . Non-parametric bootstrapping analysis was used to generate confidence intervals . Results : In the base case , pregabalin 300 mg and 450 mg increased cost per patient by £ 601 ( 95 % CI : 532 , 669 ) and £ 653 ( 587 , 727 ) and improved QALYs per patient by 0.03 ( −0.03 , 0.06 ) and 0.03 ( −0.04 , 0.08 ) respectively compared to  placebo . The cost per QALY gained ( CQG ) was £ 23,166 and £ 22,533 . In the base case population CQG for pregabalin 450 mg against duloxetine 60 mg and 120 mg was £ 19,224 and £ 14,096 , against gabapentin £ 35,737 , against tramadol £ 98,072 , and was dominated by amitriptyline . Sensitivity analysis found the cost effectiveness of pregabalin to be most sensitive to drug price and response rates . Limitations of the analysis include different definitions of response used and lack of subgroup data reported in the published studies synthesis ed , and limited data on long-term effect of therapies in fibromyalgia . Although the analysis was based on the best available evidence , the comparisons against amitriptyline and tramadol rely on old studies that were not design ed to meet current quality criteria . Conclusion : This model found pregabalin 300 mg and 450 mg to be cost effective compared with placebo and , within the limits of available evidence , against duloxetine using st and ard UK criteria in patients with fibromyalgia experiencing severe pain BACKGROUND Collaborative group intervention ( CGI ) in patients with functional somatic syndromes ( FSS ) has been shown to improve mental quality of life . OBJECTIVE To analyse incremental cost-utility of CGI compared to enhanced medical care in patients with FSS . METHODS An economic evaluation alongside a cluster-r and omised controlled trial was performed . 35 general practitioners ( GPs ) recruited 300 FSS patients . Patients in the CGI arm were offered 10 group sessions within 3months and 2 booster sessions 6 and 12months after baseline . Costs were assessed via question naire . Quality adjusted life years ( QALYs ) were calculated using the SF-6D index , derived from the 36-item short-form health survey ( SF-36 ) . We calculated patients ' net-monetary-benefit ( NMB ) , estimated the treatment effect via regression , and generated cost-effectiveness acceptability curves . RESULTS Using intention-to-treat analysis , total costs during the 12-month study period were 5777EUR in the intervention , and 6858EUR in the control group . Controlling for possible confounders , we found a small , but significant positive intervention effect on QALYs ( + 0.017 ; p=0.019 ) and an insignificant cost saving result ing from a cost-increase in the control group ( -10.5 % ; p=0.278 ) . NMB regression showed that the probability of CGI  to be cost-effective was 69 % for a willingness to pay ( WTP ) of 0EUR/QALY , increased to 92 % for a WTP of 50,000EUR/QALY and reached the level of 95 % at a WTP of 70,375EUR/QALY . Subgroup analyses yielded  that CGI was only cost-effective in severe somatic symptom severity ( PHQ-15≥15 ) . CONCLUSION CGI has a high probability to be a cost-effective treatment for FSS , in particular for patients with severe somatic symptom severity OBJECTIVES To estimate the cost-effectiveness of an adjuvant treatment course of spa treatment compared with usual care only in patients with fibromyalgia syndrome ( FM ) . METHODS 134 patients with FM , selected from a rheumatology outpatient department and from members of the Dutch FM patient association were r and omly 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 . RESULTS 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 . CONCLUSIONS 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 OBJECTIVE Our aim was to assess cost-effectiveness of mindfulness-based cognitive therapy ( MBCT ) compared with enhanced usual care ( EUC ) in treating patients with persistent medically unexplained symptoms(MUS ) . METHODS A full economic evaluation with a one year time horizon was performed from a societal perspective . Costs were assessed by prospect i ve cost diaries . Health-related Quality of Life was measured using SF-6D . Outcomes were costs per Quality -Adjusted Life Year ( QALY ) . Bootstrap simulations were performed to obtain mean costs , QALY scores and incremental cost-effectiveness ratios ( ICERs ) . RESULTS  MBCT participants ( n=55 ) had lower hospital costs and higher mental health care costs than patients who received EUC ( n=41 ) . Mean bootstrapped costs  for MBCT were € 6269 , and € 5617 for EUC ( 95 % uncertainty interval for difference : -€1576 ; € 2955 ) . QALYs were 0.674 for MBCT and 0.663 for EUC . MBCT was on average more effective and more costly than EUC , result ing in an ICER of € 56,637 per QALY gained . At a willingness to pay of € 80,000 per QALY , the probability that MBCT is cost-effective is 57 % . CONCLUSION Total costs were not statistically significantly different between MBCT and EUC . However , MBCT seemed to cause a shift in the use of health care re sources as mental health care costs were higher and hospital care costs lower in the MBCT condition . Due to the higher drop-out in the EUC condition the cost-effectiveness of MBCT might have been underestimated . The shift in health care use might lead to more effective care for patients with persistent MUS . The longer-term impact of MBCT for patients with persistent MUS needs to be further studied Background Nurse led self-help treatments for people with chronic fatigue syndrome/myalgic encephalitis ( CFS/ME ) have been shown to be effective in reducing fatigue but their cost-effectiveness is unknown . Methods Cost-effectiveness analysis conducted alongside a single blind r and omised controlled trial comparing pragmatic rehabilitation ( PR ) and supportive listening ( SL ) delivered by primary care nurses , and treatment as usual ( TAU ) delivered by the general practitioner ( GP ) in North West Engl and . A within trial analysis was conducted comparing the costs and quality adjusted life years ( QALYs ) measured within the time frame of the trial . 296 patients aged 18 and over with CFS/ME diagnosed using the Oxford criteria were included in the cost-effectiveness analysis . Results Treatment as usual is less expensive and leads to better patient outcomes compared with Supportive Listening . Treatment as usual is also less expensive than Pragmatic Rehabilitation . PR was effective at reducing fatigue in the short term , but the impact of the intervention on QALYs was uncertain . However , based on the results of this trial , PR is unlikely to be cost-effective in this patient population . Conclusions This analysis does not support the introduction of SL . Any benefits generated by PR are unlikely to be of sufficient magnitude to warrant recommending PR for this patient group on cost-effectiveness grounds alone . However , dissatisfaction with current treatment options means simply continuing with ‘ treatment as usual ’ in primary care is unlikely to be acceptable to patients and practitioners . Trial registration The trial registration number is I RCT The aim of this study was to analyze the cost utility of a group-based form of acceptance and commitment therapy ( GACT ) in patients with fibromyalgia ( FM ) compared with patients receiving recommended pharmacological treatment ( RPT ) or on a waiting list ( WL ) . The data were derived from a previously published study , a r and omized controlled trial that focused on clinical outcomes . Health economic outcomes included health-related quality of life and health care use at baseline and at 6-month follow-up using the EuroQoL and the Client Service Receipt Inventory , respectively . Analyses included quality -adjusted life years , direct and indirect cost differences , and incremental cost effectiveness ratios . A total of 156 FM patients were r and omized ( 51 GACT , 52 RPT , 53 WL ) . GACT was related to significantly less direct costs over the 6-month study period compared with both control arms ( GACT € 824.2 ± 1,062.7 vs RPT € 1,730.7 ± 1,656.8 vs WL € 2,462.7 ± 2,822.0 ) . Lower direct costs  for GACT compared with RPT were due to lower costs from primary care visits and FM-related medications . The incremental cost effectiveness ratios were dominant in the completers ' analysis and remained robust in the sensitivity analyses . In conclusion , acceptance and commitment therapy appears to be a cost-effective treatment compared with RPT in patients with FM . PERSPECTIVE Decision-makers have to prioritize their budget on the treatment option that is the most cost effective for the management of a specific patient group . From government as well as health care perspectives , this study shows that a GACT  is more cost effective than pharmacological treatment in management of FM BACKGROUND Most knowledge on chronic fatigue ( CF ) and chronic fatigue syndrome ( CFS ) is based on clinical studies , not representative of the general population . This study aim ed to assess the prevalence of fatigue in an adult general population and to identify associations with lifestyle factors . METHODS Total 22,500 residents of Nijmegen were selected at r and om and interviewed by question naire . Data on 9062 respondents ( 43 % response ) were analysed , taken into account age , gender and concomitant disease . Subjects were classified into four groups : not fatigued ( NF , reference group ) , short-term fatigue ( SF , < 6 months ) , chronic fatigue ( CF , > or=6 months ) and CFS-like fatigue ( in accordance with the Center for Disease Control criteria for CFS , without clinical confirmation ) . RESULTS Our study population showed the following breakdown : NF 64.4 % ( 95 % CI 63.6 - 65.6 % ) , SF 4.9 % ( 95 % CI 4.5 - 5.4 % ) , CF 30.5 % ( 95 % CI 29.5 - 31.4 % ) and CFS-like fatigue 1.0 % ( 95 % CI 0.8 - 1.2 % ) . Compared with the NF group , more of the CFS respondents were female [ odds ratio ( OR ) = 1.9 ] , obese ( OR = 4.1 ) , using analgesics ( OR = 7.8 ) , had a low alcohol intake ( OR = 0.4 ) , were eating less 
    Output:
    
Considering the limited comparability due to the heterogeneity of the studies , group interventions might be more cost-effective than individual interventions .