Cost-utility of home-based fatigue self-management versus usual care for the treatment of chronic fatigue syndrome

Background: Chronic fatigue syndrome (CFS) 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. Objective: 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 CFS. Methods: 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 (NMB) were calculated as measures of cost-effectiveness. Results: 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. Conclusions: In primary care patients with severe CFS, the low-cost FSM appears to be a cost-effective treatment.