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Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis

Author

Listed:
  • McCrone, Paul R.
  • Sharpe, Michael
  • Chalder, Trudie
  • Knapp, Martin
  • Johnson, Anthony L.
  • Goldsmith, Kimberley A.
  • White, Peter D.

Abstract

Background The PACE trial compared the effectiveness of adding adaptive pacing therapy (APT), cognitive behaviour therapy (CBT), or graded exercise therapy (GET), to specialist medical care (SMC) for patients with chronic fatigue syndrome. This paper reports the relative cost-effectiveness of these treatments in terms of quality adjusted life years (QALYs) and improvements in fatigue and physical function. Methods Resource use was measured and costs calculated. Healthcare and societal costs (healthcare plus lost production and unpaid informal care) were combined with QALYs gained, and changes in fatigue and disability; incremental cost-effectiveness ratios (ICERs) were computed. Results SMC patients had significantly lower healthcare costs than those receiving APT, CBT and GET. If society is willing to value a QALY at £30,000 there is a 62.7% likelihood that CBT is the most cost-effective therapy, a 26.8% likelihood that GET is most cost effective, 2.6% that APT is most cost-effective and 7.9% that SMC alone is most cost-effective. Compared to SMC alone, the incremental healthcare cost per QALY was £18,374 for CBT, £23,615 for GET and £55,235 for APT. From a societal perspective CBT has a 59.5% likelihood of being the most cost-effective, GET 34.8%, APT 0.2% and SMC alone 5.5%. CBT and GET dominated SMC, while APT had a cost per QALY of £127,047. ICERs using reductions in fatigue and disability as outcomes largely mirrored these findings. Conclusions Comparing the four treatments using a health care perspective, CBT had the greatest probability of being the most cost-effective followed by GET. APT had a lower probability of being the most cost-effective option than SMC alone. The relative cost-effectiveness was even greater from a societal perspective as additional cost savings due to reduced need for informal care were likely.

Suggested Citation

  • McCrone, Paul R. & Sharpe, Michael & Chalder, Trudie & Knapp, Martin & Johnson, Anthony L. & Goldsmith, Kimberley A. & White, Peter D., 2012. "Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis," LSE Research Online Documents on Economics 45274, London School of Economics and Political Science, LSE Library.
  • Handle: RePEc:ehl:lserod:45274
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    Cited by:

    1. Desirée Vos-Vromans & Silvia Evers & Ivan Huijnen & Albère Köke & Minou Hitters & Nieke Rijnders & Menno Pont & André Knottnerus & Rob Smeets, 2017. "Economic evaluation of multidisciplinary rehabilitation treatment versus cognitive behavioural therapy for patients with chronic fatigue syndrome: A randomized controlled trial," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-21, June.
    2. Huazhen Wang & Xin Liu & Bing Lv & Fan Yang & Yanzhu Hong, 2014. "Reliable Multi-Label Learning via Conformal Predictor and Random Forest for Syndrome Differentiation of Chronic Fatigue in Traditional Chinese Medicine," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-14, June.
    3. Margreet S H Wortman & Joran Lokkerbol & Johannes C van der Wouden & Bart Visser & Henriëtte E van der Horst & Tim C olde Hartman, 2018. "Cost-effectiveness of interventions for medically unexplained symptoms: A systematic review," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-23, October.
    4. Claudia Fischer & Susanne Mayer & Nataša Perić & Judit Simon, 2022. "Harmonization issues in unit costing of service use for multi-country, multi-sectoral health economic evaluations: a scoping review," Health Economics Review, Springer, vol. 12(1), pages 1-13, December.

    More about this item

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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