Cost-Utility of Home-Based Fatigue Self-Management versus Usual Care for the Treatment of Chronic Fatigue Syndrome

Chronic fatigue syndrome is a complex chronic condition with large negative impact on patients' function and quality of life. Efficacy and cost-effectiveness of cognitive behavioral intervention remain inconclusive.

To evaluate the cost-utility of a home-based fatigue self-management (FSM) intervention as compared to usual care among primary care patients with severe chronic fatigue syndrome (CFS).

An economic evaluation alongside of a randomized controlled study design was used. Cost and utility data were collected from 137 patients with severe CFS at baseline and 1-year follow-up. The FSM group (n=89) received self-delivered cognitive behavioral self-management intervention and the usual care group (n=48) received regular medical care. Cost was measured by total costs (direct, indirect, and intervention costs) during the follow-up period. Quality-adjusted life years (QALY), as the utility measure, were derived from the Medical Outcomes Survey Short Form-36. A societal perspective was adopted. Bootstrapped incremental cost-utility ratios (ICURs) and net monetary benefit were calculated as measures of cost-effectiveness.

Baseline individual characteristics were similar between the two groups. The intervention was well-received by the participants with only minimum attrition. At the end of one year post-intervention, FSM dominated usual care in terms of ICUR in both the intention-to-treat analysis and the complete-cases-only analysis. Net monetary benefit analysis showed that FSM has higher probability of achieving positive net monetary across the entire range of possible societal willingness-to-pay for fatigue symptom management.

In primary care patients with severe CFS, the low-cost FSM appears to be a cost-effective treatment.