Abstract
BackgroundNurse led self-help treatments for people with chronic fatigue syndrome/myalgic encephalitis (CFS/ME) have been shown to be effective in reducing fatigue but their cost-effectiveness is unknown.MethodsCost-effectiveness analysis conducted alongside a single blind randomised controlled trial comparing pragmatic rehabilitation (PR) and supportive listening (SL) delivered by primary care nurses, and treatment as usual (TAU) delivered by the general practitioner (GP) in North West England. A within trial analysis was conducted comparing the costs and quality adjusted life years (QALYs) measured within the time frame of the trial. 296 patients aged 18 and over with CFS/ME diagnosed using the Oxford criteria were included in the cost-effectiveness analysis.ResultsTreatment as usual is less expensive and leads to better patient outcomes compared with Supportive Listening. Treatment as usual is also less expensive than Pragmatic Rehabilitation. PR was effective at reducing fatigue in the short term, but the impact of the intervention on QALYs was uncertain. However, based on the results of this trial, PR is unlikely to be cost-effective in this patient population.ConclusionsThis analysis does not support the introduction of SL. Any benefits generated by PR are unlikely to be of sufficient magnitude to warrant recommending PR for this patient group on cost-effectiveness grounds alone. However, dissatisfaction with current treatment options means simply continuing with ‘treatment as usual’ in primary care is unlikely to be acceptable to patients and practitioners.Trial registrationThe trial registration number is IRCTN74156610
Highlights
Nurse led self-help treatments for people with chronic fatigue syndrome/myalgic encephalitis (CFS/ME) have been shown to be effective in reducing fatigue but their cost-effectiveness is unknown
Decision problem The decision problem addressed in this paper is to assess the cost-effectiveness of three treatment strategies for CFS/ME, Pragmatic Rehabilitation (PR), Supportive Listening (SL) and Treatment as Usual (TAU) delivered by general practitioner (GP) in a primary care setting, in the budget constrained system of the UK National Health Service (NHS)
supporting listening (SL) is a variant of a non-specific counselling intervention originally designed for common psychological difficulties, while TAU represents the treatment as usual or management received by patients with CFS/ME from their GP
Summary
Nurse led self-help treatments for people with chronic fatigue syndrome/myalgic encephalitis (CFS/ME) have been shown to be effective in reducing fatigue but their cost-effectiveness is unknown. Chronic fatigue syndrome (or myalgic encephalomyelitis / encephalitis or ME; hereafter abbreviated to CFS/ME) is characterised by a principal complaint of fatigue, of sufficient duration and severity to impair functioning [1]. PR provides an explanation for patients’ symptoms, based on a model in which CFS occurs as a consequence of physiological dysregulation associated with inactivity, disturbance of sleep and circadian rhythms, and the somatic symptoms of arousal or anxiety. The explanation provides the rationale for a rehabilitation program, developed collaboratively with the patient, which includes a graded return to activity and normalisation of sleep patterns. PR was effective after 18 weeks of treatment in reducing fatigue, depression and improving sleep, but these effects had diminished one year later [7]
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