Economic burden of chronic fatigue syndrome in Georgia

Introduction Chronic fatigue syndrome (CFS) is a debilitating chronic illness affecting 1 to 4 million people in the U.S. Understanding its costs is important to prioritizing the allocation of resources and in evaluating initiatives designed to improve diagnosis and management of the illness. The Wichita study showed that CFS cost a 37% decline in household productivity, 54% reduction in labor force productivity and $9.1 billion annual total value of lost productivity in U.S. in the year 2002. The current study is to estimate direct costs associated with medical care for CFS and indirect costs (CFS impact on education, employment, and earnings).

Methods Using data collected in a cross-sectional population-based study of CFS in Georgia, we estimated the effect of clinically-confirmed CFS on direct medical costs (inpatient hospitalizations, provider visits, prescription medication spending, other medical supplies and services) and productivity (employment and earnings). Covariates were used to adjust for potentially confounding factors related to age, sex, race, education, and location of residence. Estimates were weighted to reflect putative response-rate adjusted sampling rates.

Results Individuals with CFS had estimated average annual direct medical costs of $5,684. After adjusting for demographic covariates, they spent $3,085 more than “well” individuals (a subset of the non-CFS population with no CFS associated symptoms), primarily due to increased provider encounters and prescription medication use. For indirect cost, individuals with CFS reported $14,027 less annual household earnings and 19 % lower probability of working than “well” individuals. Of individuals without CFS, people with a college degree reported $18,899 more annual household earnings than those with less than college educational attainment. After adjusting for demographic covariates, individuals with CFS onset before age 25 were 59.6% less likely to complete college than those with CFS onset at or after 25 (p<0.01). Forestalled educational attainment accounted for one-fifth of the reduction in earnings associated with CFS.

Conclusions The state of Georgia has roughly 4.7 million people age 18-59. If 2.5 percent of them have CFS, then illness could account for almost $350 million in healthcare expenditures and $1.6 billion in lost productivity in Georgia. Extrapolating our data to the United States, CFS could account for as much as $13 billion in healthcare expenditures and $59 billion of lost productivity. Delayed help-seeking may lead to more serious and more expensive health problems in the future.