Topic: IDSA/CDC reasons to NOT treat Lyme patients- $$$
Honored Contributor (10K+ posts)
Member # 5829
For the love of money... or why IDSA Lyme guidelines restrict adequate treatment.
Note the IDSA/CDC authors names on the 2 studies below.
I also like the mention of Lyme anxiety too. NOT!
Study One- "For late presentations of possible Lyme disease, no testing-no treatment or two-step testing avoided 552 to 990 unnecessary treatments and unnecessary expenditures of $1.85 million to $3.33 million per 1000 patients compared with empirical treatment of all such patients (Table 5)."
Study Two- "Our analysis estimates that it will cost $86 221 to prevent one case of late Lyme disease if all seropositive patients with fatigue and myalgia in the most endemic region are treated with intravenous antibiotics."
Ann Intern Med. 1998 Jan 1;128(1):37-48. Links Test-treatment strategies for patients suspected of having Lyme disease: a cost-effectiveness analysis.
Nichol G, Dennis DT, Steere AC, Lightfoot R, Wells G, Shea B, Tugwell P. Ottawa Civic Hospital, Ontario, Canada.
PURPOSE: To examine the cost-effectiveness of test-treatment strategies for patients suspected of having Lyme disease.
DATA SOURCES: The medical literature was searched for information on outcomes and costs. Expert opinion was sought for information on utilities.
STUDY SELECTION: Articles that described patient population, diagnostic criteria, dose and duration of therapy, and criteria for assessment of outcomes.
DATA EXTRACTION: The decision analysis evaluated the following strategies: 1) no testing-no treatment; 2) testing with enzyme-linked immunosorbent assay (ELISA) followed by antibiotic treatment of patients with positive results; 3) two-step testing with ELISA followed by Western blot and antibiotic treatment for patients with positive results on either test; and 4) empirical antibiotic therapy.
Three patient scenarios were considered: myalgic symptoms, rash resembling erythema migrans, and recurrent oligoarticular inflammatory arthritis. Results were calculated as costs per quality-adjusted life-year and were subjected to sensitivity analysis.
Adjustment was made for the diagnostic value of common clinical features of Lyme disease.
DATA SYNTHESIS: For myalgic symptoms without other features suggestive of Lyme disease, the no testing-no treatment strategy was most economically attractive (that is, had the most favorable cost-effectiveness ratio).
For rash, empirical antibiotic therapy was less costly and more effective than other strategies. For oligoarticular arthritis with a history of rash and tick bite, two-step testing was associated with the lowest cost-effectiveness ratio.
Testing with ELISA and empirical antibiotic therapy cost an additional $880,000 and $34,000 per quality-adjusted life-year, respectively.
For oligoarticular arthritis with one or no other features suggestive of Lyme disease, two-step testing was most economically attractive.
CONCLUSIONS: Neither testing nor antibiotic treatment is cost-effective if the pretest probability of Lyme disease is low.
Empirical antibiotic therapy is recommended if the pretest probability is high, and two-step testing is recommended if the pretest probability is intermediate.
Division of Rheumatology, Kentucky Clinic J515, University of Kentucky Medical Center, Lexington 40536-0284.
PURPOSE: To examine the cost-effectiveness of empirical, parenteral antibiotic treatment of patients with chronic fatigue and myalgia and a positive serologic result for Lyme disease who lack classic manifestations.
DATA SOURCES: Peer-reviewed journals, opinion of experts in the field, and published epidemiologic reports.
STUDY SELECTION: Consensus by authors on articles that indicated methods for patient selection; on criteria used for diagnosis; on immunologic methods used for classifying patients; on the dose and duration of therapy; and on criteria by which responses to therapy were ascertained.
DATA EXTRACTION: In a cost-effectiveness model, the costs and benefits of empirical parenteral therapy for patients seropositive for Lyme disease were compared with a strategy in which only patients having classical symptoms of Lyme disease were treated.
DATA SYNTHESIS: In areas endemic for Lyme disease, the incidence of false-positive serologic results in patients with nonspecific myalgia or fatigue exceeds by four to one the incidence of true-positive results in patients with nonclassical infections.
Treatment of the former group of patients costs $86,221 for each true-positive patient treated. The empirical strategy causes 29 cases of drug toxicity for every case in the more conservative strategy.
If patients were willing to pay $3485 to eliminate anxiety about not treating possible true Lyme disease, the empirical strategy would break even. (MY note- they are talking about out-of-pocket expenses here and NOT using your insurance.)
CONCLUSION: For most patients with a positive Lyme antibody titer whose only symptoms are nonspecific myalgia or fatigue the risks and costs of empirical parenteral antibiotic therapy exceed the benefits.
Only when the value of patient anxiety about leaving a positive test untreated exceeds the cost of such therapy is the empirical treatment cost-effective.
Publication Types: PMID: 8357117 [PubMed - indexed for MEDLINE]
This is an excerpt from the second article:
"Patients with positive serologic results who do not receive antibiotic therapy may be at some risk for subsequent development of the symptoms of late-stage Lyme disease. No long-term follow-up studies exist of patients found to have positive serologic results with no or atypical symptoms, so the precise risk for late Lyme disease is not known. Nor is it known whether outcomes in patients developing symptoms later are worse if treatment has been delayed. Because the fatigue and myalgia syndrome is a chronic state, and most patients will have substantial evaluation and follow-up before the possibility of occult Lyme disease is entertained and antibiotic therapy is considered, it is unlikely that such patients will ever acquire either the rash of Lyme disease or cardiac involvement because these occur very early. Because arthritis and Lyme neuroborreliosis can be late symptoms of Lyme disease, they are the most likely symptoms of Lyme disease for which seropositive patients are at risk. We have, therefore, assumed that the seropositive patients who actually have persistent subclinical Lyme disease have a 5% chance for developing neurologic symptoms and a 10% chance for developing arthritis from the Lyme spirochete. It must be understood that these estimates are subjective, because no evidence exists to assist in the prediction of later symptomatic Lyme disease in seropositive patients. The effect of varying the above assumptions was examined in the sensitivity analysis discussed below. " ...........................................
See, what they are saying is NO ONE KNOWS what happens when lyme disease goes latent. That is what they are talking about here. A patient is bitten and contracts the disease and has a positive serology, but no symptoms. Very common in lyme country where typically 10%+ of population is asymptomatic. And NO ONE HAS EVER STUDIED THIS, or what happens when the spirochete goes latent and then re-emerges.
Basically, it causes encephalopathy, NOT the acute neuro symptoms which occur early in disease such as facial palsy and meningitis. And here, steere just pulls out of his *** a figure of 10% for arthritis, 5% for late neurolyme emerging in latent cases. He has NO DATA to support this claim other than his own foolish prejudices towards joint disease. Moreover, he has NO DATA which demonstrates the full range of late neurological disease. He is so biased here that he assumes a very narrow spectrum for lyme, without adequately exploring or ruling out other ailments. To this day, NO ONE has followed asymptomatic lyme patients in long term. Of course, such a study would/could be very unethical. But if they don't do it, we don't know what is happening.
Typical steere BS. He's just a foolish, arrogant, materialistic twerp.
Posts: 523 | From Stillwater,OK,USA | Registered: Sep 2004
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Frequent Contributor (5K+ posts)
Member # 10397
I guess they aren't considering the loss of income & taxes due to being too ill to work in their equation.
This is just more proof (to me) that the denial of proper treatment, benefits, insurance, etc. to people with Lyme is based on a conspiracy.
I just can't see how the cost of treating when the exposure is detected (or having better tests - which is what is really needed) can save money. I haven't had a regular job since 2000 - hence, I haven't been paying taxes, either.
I think it's more than just a money issue.
Posts: 7772 | From Northeast, again... | Registered: Oct 2006
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TINCUP, sure stinks here ... HOG WASH! great job of breaking up the article so we could read it!
bruce, could you help us neuro lymies out who can NOT read long, solid block text, and break it up pretty please?
to edit, click on paper/pencil icon to right of you name.
could you break this up into ONE sentence paragraphs since it is so much TECHNICAL words used?? thanks for your consideration of our needs.
tc, both these studies were done in 93 and 98 correct ??
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Frequent Contributor (5K+ posts)
Member # 10375
I saw the title of the post and thought
It has been my personal belief that acknowledgement
Of chronic Lyme (and all of it's ramifications)
Could and would bankrupt our healthcare system as we know it.
That is akin to all of the mortgage companies that had to be
Bailed out to stay afloat lately. Ya' think?
No, no......better to deny the existence of such malady and
then the poor ole "Big Pharma Political Machine" would never be able to recoup their
poorly invested research money. Why? Because the cure for all this stuff is simple
antibiotics that they don't have the patent for any longer and cannot charge the high prices to
get well any longer. The generic folks would all get rich in a hurry.
Then the "Big Pharma Political Machine" would go broke!
Gee, kinda makes ya want to shead a tear for these bozo's that have been keeping us sick for so long with all their lies.
now don't it?
-------------------- I am not a doctor...opinions expressed are from personal experiences only and should never be viewed as coming from a healthcare provider. zman Posts: 2527 | From safety harbor florida(origin Cleve., Ohio | Registered: Jan 2004
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Honored Contributor (10K+ posts)
Member # 5829
"Gee, kinda makes ya want to shead a tear for these bozo's that have been keeping us sick for so long with all their lies."