Cost-effectiveness of chronic fatigue self-management in primary care: A randomized controlled trial

Chronic fatigue, characterized by persistent and recurring fatigue that cannot be alleviated by rest, is a common condition in primary care. Despite its impact on quality of life and health care costs, efficacious treatment options in primary care remains limited. We conducted a randomized controlled trial testing the cost and effectiveness of a cognitive behavioral fatigue self-management (FSM) intervention among 111 middle-aged and older primary care patients with chronic fatigue syndrome over a 12-month period. Effectiveness was measured by the Fatigue Severity Scale (FSS). Health care resource use was measured by a health care utilization diary. Resource categories included provider visits, diagnostic tests, emergency room visits, hospital admissions, and hours of informal care received. We used ordinary least squares model and generalized linear model to estimate the treatment effect on effectiveness and health care expenditures, respectively. Cost-effectiveness was measured by the incremental cost-effectiveness ratio and net monetary benefit. We found that compared to usual care, FSM led to significant improvement in the mean FSS score (-0.67, 95% CI: -1.16, -0.18) and lower monthly total health care expenditures (-$294, 95% CI: -$823, $338). Incremental cost-effectiveness and net monetary benefit analysis showed that FSM is likely to be cost-effective as compared to usual care. We conclude that the cognitive behavioral FSM intervention is more cost effective as compared to usual care. Future studies involving more patients from multiple geographic regions are needed to confirm these findings. More research is needed to examine long-term impact of the FSM intervention.