Cost-effectiveness of chronic fatigue self-management versus usual care: a pilot randomized controlled trial

Hongdao Meng, Fred Friedberg, Melissa Castora-Binkley, Hongdao Meng, Fred Friedberg, Melissa Castora-Binkley

Abstract

Background: Fatigue is a common yet difficult to treat condition in primary care. The objective of this study is to evaluate the cost-effectiveness of a brief cognitive behavioral therapy (CBT) based fatigue self-management (FSM) intervention as compared to usual care among patients with chronic fatigue in primary care.

Methods: An economic evaluation alongside of a parallel randomized controlled study design was used. Computer-generated variable-sized block randomization plan was used to assign patients into treatment groups and data collection staff were blinded to group assignments. Patients aged between 18 and 65 years with at least six months of persistent fatigue and no medical or psychiatric exclusions were enrolled from a large primary care practice in Stony Brook, New York. The FSM group (n = 37) received two sessions of a nurse-delivered, fatigue self-management protocol and a self-help book and the usual care group (n = 36) received regular medical care. The effectiveness measure was the Fatigue Severity Scale and the cost measure was total health care expenditures derived from monthly health services use diaries during follow-up. A societal perspective was adopted and bootstrapped incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) were calculated as measures of cost-effectiveness.

Results: The ICER for FSM was -$$2358, indicating that FSM dominates UC and it may generate societal cost savings as compared to usual care. Complete case analysis yielded smaller ICER (-$1199) with greater uncertainties. Net monetary benefit analysis showed that FSM has a probability of 0.833 (95% CI: 0.819, 0.847) to achieve positive NMB and the favorable results were not sensitive to assumptions about informal care or treatment costs.

Conclusion: This economic evaluation found initial evidence that a two-session brief CBT-based FSM may be cost-effective as compared to usual care over 12 months. The FSM intervention is potentially a promising intervention for chronic fatigue patients in primary care. Additional research is needed to examine the reproducibility and generalizability of these findings.

Trial registration: ClinicalTrials.gov (NCT00997451, March 28, 2009).

Figures

Figure 1
Figure 1
CONSORT flow diagram.
Figure 2
Figure 2
Plots of incremental cost-effectiveness ratios for fatigue self-management and attention control from bootstrapped samples. Note: Four quadrants: northeast (more effective, more costly), northwest (less effective, more costly), southwest (less effective, less costly), and southeast (more effective, less costly). Imputed sample included 26 individuals with imputed fatigue assessment data.
Figure 3
Figure 3
Cost-effectiveness acceptability curve comparing fatigue self-management versus usual care, base case and sensitivity analysis. Note: Scenario 1: informal help was valued at $0; Scenario 2: intervention cost was valued at 2 times of the base case rate.

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