Abstract
BACKGROUND: There is a paucity of evidence relating to the cost-effectiveness of alternative treatment responses to chronic fatigue. AIM: To compare the relative costs and outcomes of counselling versus cognitive behaviour therapy (CBT) provided in primary care settings for the treatment of fatigue. DESIGN OF STUDY: A randomised controlled trial incorporating a cost-consequences analysis. SETTING: One hundred and twenty-nine patients from 10 general practices across London and the South Thames region who had experienced symptoms of fatigue for at least three months. METHOD: An economic analysis was performed to measure costs of therapy, other use of health services, informal care-giving, and lost employment. The principal outcome measure was the Fatigue Questionnaire; secondary measures were the Hospital Anxiety and Depression Scale and a social adjustment scale. RESULTS: Although the mean cost of treatment was higher for the CBT group (164 Pounds, standard deviation = 67) than the counselling group (109 Pounds, SD = 49; 95% confidence interval = 35 to 76, P < 0.001), a comparison of change scores between baseline and six-month assessment revealed no statistically significant differences between the two groups in terms of aggregate health care costs, patient and family costs or incremental cost-effectiveness (cost per unit of improvement on the fatigue score). CONCLUSIONS: Counselling and CBT both led to improvements in fatigue and related symptoms, while slightly reducing informal care and lost productivity costs. Counselling represents a less costly (and more widely available) intervention but no overall cost-effectiveness advantage was found for either form of therapy.
Full Text
The Full Text of this article is available as a PDF (77.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Barber J. A., Thompson S. G. Analysis and interpretation of cost data in randomised controlled trials: review of published studies. BMJ. 1998 Oct 31;317(7167):1195–1200. doi: 10.1136/bmj.317.7167.1195. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bombardier C. H., Buchwald D. Chronic fatigue, chronic fatigue syndrome, and fibromyalgia. Disability and health-care use. Med Care. 1996 Sep;34(9):924–930. doi: 10.1097/00005650-199609000-00005. [DOI] [PubMed] [Google Scholar]
- Chalder T., Berelowitz G., Pawlikowska T., Watts L., Wessely S., Wright D., Wallace E. P. Development of a fatigue scale. J Psychosom Res. 1993;37(2):147–153. doi: 10.1016/0022-3999(93)90081-p. [DOI] [PubMed] [Google Scholar]
- Deale A., Chalder T., Marks I., Wessely S. Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. Am J Psychiatry. 1997 Mar;154(3):408–414. doi: 10.1176/ajp.154.3.408. [DOI] [PubMed] [Google Scholar]
- Fulcher K. Y., White P. D. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. BMJ. 1997 Jun 7;314(7095):1647–1652. doi: 10.1136/bmj.314.7095.1647. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gray A. M., Marshall M., Lockwood A., Morris J. Problems in conducting economic evaluations alongside clinical trials. Lessons from a study of case management for people with mental disorders. Br J Psychiatry. 1997 Jan;170:47–52. doi: 10.1192/bjp.170.1.47. [DOI] [PubMed] [Google Scholar]
- Harvey I., Nelson S. J., Lyons R. A., Unwin C., Monaghan S., Peters T. J. A randomized controlled trial and economic evaluation of counselling in primary care. Br J Gen Pract. 1998 Mar;48(428):1043–1048. [PMC free article] [PubMed] [Google Scholar]
- Lloyd A. R., Pender H. The economic impact of chronic fatigue syndrome. Med J Aust. 1992 Nov 2;157(9):599–601. [PubMed] [Google Scholar]
- Ridsdale L., Godfrey E., Chalder T., Seed P., King M., Wallace P., Wessely S., Fatigue Trialists' Group Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial. Br J Gen Pract. 2001 Jan;51(462):19–24. [PMC free article] [PubMed] [Google Scholar]
- Sharpe M., Hawton K., Simkin S., Surawy C., Hackmann A., Klimes I., Peto T., Warrell D., Seagroatt V. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial. BMJ. 1996 Jan 6;312(7022):22–26. doi: 10.1136/bmj.312.7022.22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]