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Cost-effectiveness of chronic fatigue self-management versus usual care: a pilot randomized controlled trial.

Meng H, Friedberg F, Castora-Binkley M - BMC Fam Pract (2014)

Bottom Line: A societal perspective was adopted and bootstrapped incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) were calculated as measures of cost-effectiveness.Net monetary benefit analysis showed that FSM has a probability of 0.833 (95% CI: 0.819, 0.847) to achieve positive NMB and the favorable results were not sensitive to assumptions about informal care or treatment costs.This economic evaluation found initial evidence that a two-session brief CBT-based FSM may be cost-effective as compared to usual care over 12 months.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Fatigue is a common yet difficult to treat condition in primary care. The objective of this study is to evaluate the cost-effectiveness of a brief cognitive behavioral therapy (CBT) based fatigue self-management (FSM) intervention as compared to usual care among patients with chronic fatigue in primary care.

Methods: An economic evaluation alongside of a parallel randomized controlled study design was used. Computer-generated variable-sized block randomization plan was used to assign patients into treatment groups and data collection staff were blinded to group assignments. Patients aged between 18 and 65 years with at least six months of persistent fatigue and no medical or psychiatric exclusions were enrolled from a large primary care practice in Stony Brook, New York. The FSM group (n = 37) received two sessions of a nurse-delivered, fatigue self-management protocol and a self-help book and the usual care group (n = 36) received regular medical care. The effectiveness measure was the Fatigue Severity Scale and the cost measure was total health care expenditures derived from monthly health services use diaries during follow-up. A societal perspective was adopted and bootstrapped incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) were calculated as measures of cost-effectiveness.

Results: The ICER for FSM was -$$2358, indicating that FSM dominates UC and it may generate societal cost savings as compared to usual care. Complete case analysis yielded smaller ICER (-$1199) with greater uncertainties. Net monetary benefit analysis showed that FSM has a probability of 0.833 (95% CI: 0.819, 0.847) to achieve positive NMB and the favorable results were not sensitive to assumptions about informal care or treatment costs.

Conclusion: This economic evaluation found initial evidence that a two-session brief CBT-based FSM may be cost-effective as compared to usual care over 12 months. The FSM intervention is potentially a promising intervention for chronic fatigue patients in primary care. Additional research is needed to examine the reproducibility and generalizability of these findings.

Trial registration: ClinicalTrials.gov (NCT00997451, March 28, 2009).

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Related in: MedlinePlus

Cost-effectiveness acceptability curve comparing fatigue self-management versus usual care, base case and sensitivity analysis. Note: Scenario 1: informal help was valued at $0; Scenario 2: intervention cost was valued at 2 times of the base case rate.
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Fig3: Cost-effectiveness acceptability curve comparing fatigue self-management versus usual care, base case and sensitivity analysis. Note: Scenario 1: informal help was valued at $0; Scenario 2: intervention cost was valued at 2 times of the base case rate.

Mentions: FigureĀ 3 presents the cost-effectiveness acceptability curve for FSM as compared to UC, as well as acceptability curves under the two scenarios of the sensitivity analysis. Scenario 1 assumes that the unit cost of informal care equals to zero and scenario 2 assumes that the intervention costs are 100 percent higher than the costs calculated in the study. For the base case, even if society values each point reduction in FSS score at $0, the probability that the FSM would generate a positive NMB is 0.833 (95% CI: 0.819, 0.847). Reducing the value of informal care had virtually no impact on NMB and doubling the intervention costs reduced the probability of positive NMB to 0.735 (95% CI: 0.710, 0.760) assuming $0 willingness-to-pay.Figure 3


Cost-effectiveness of chronic fatigue self-management versus usual care: a pilot randomized controlled trial.

Meng H, Friedberg F, Castora-Binkley M - BMC Fam Pract (2014)

Cost-effectiveness acceptability curve comparing fatigue self-management versus usual care, base case and sensitivity analysis. Note: Scenario 1: informal help was valued at $0; Scenario 2: intervention cost was valued at 2 times of the base case rate.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4260238&req=5

Fig3: Cost-effectiveness acceptability curve comparing fatigue self-management versus usual care, base case and sensitivity analysis. Note: Scenario 1: informal help was valued at $0; Scenario 2: intervention cost was valued at 2 times of the base case rate.
Mentions: FigureĀ 3 presents the cost-effectiveness acceptability curve for FSM as compared to UC, as well as acceptability curves under the two scenarios of the sensitivity analysis. Scenario 1 assumes that the unit cost of informal care equals to zero and scenario 2 assumes that the intervention costs are 100 percent higher than the costs calculated in the study. For the base case, even if society values each point reduction in FSS score at $0, the probability that the FSM would generate a positive NMB is 0.833 (95% CI: 0.819, 0.847). Reducing the value of informal care had virtually no impact on NMB and doubling the intervention costs reduced the probability of positive NMB to 0.735 (95% CI: 0.710, 0.760) assuming $0 willingness-to-pay.Figure 3

Bottom Line: A societal perspective was adopted and bootstrapped incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) were calculated as measures of cost-effectiveness.Net monetary benefit analysis showed that FSM has a probability of 0.833 (95% CI: 0.819, 0.847) to achieve positive NMB and the favorable results were not sensitive to assumptions about informal care or treatment costs.This economic evaluation found initial evidence that a two-session brief CBT-based FSM may be cost-effective as compared to usual care over 12 months.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Fatigue is a common yet difficult to treat condition in primary care. The objective of this study is to evaluate the cost-effectiveness of a brief cognitive behavioral therapy (CBT) based fatigue self-management (FSM) intervention as compared to usual care among patients with chronic fatigue in primary care.

Methods: An economic evaluation alongside of a parallel randomized controlled study design was used. Computer-generated variable-sized block randomization plan was used to assign patients into treatment groups and data collection staff were blinded to group assignments. Patients aged between 18 and 65 years with at least six months of persistent fatigue and no medical or psychiatric exclusions were enrolled from a large primary care practice in Stony Brook, New York. The FSM group (n = 37) received two sessions of a nurse-delivered, fatigue self-management protocol and a self-help book and the usual care group (n = 36) received regular medical care. The effectiveness measure was the Fatigue Severity Scale and the cost measure was total health care expenditures derived from monthly health services use diaries during follow-up. A societal perspective was adopted and bootstrapped incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) were calculated as measures of cost-effectiveness.

Results: The ICER for FSM was -$$2358, indicating that FSM dominates UC and it may generate societal cost savings as compared to usual care. Complete case analysis yielded smaller ICER (-$1199) with greater uncertainties. Net monetary benefit analysis showed that FSM has a probability of 0.833 (95% CI: 0.819, 0.847) to achieve positive NMB and the favorable results were not sensitive to assumptions about informal care or treatment costs.

Conclusion: This economic evaluation found initial evidence that a two-session brief CBT-based FSM may be cost-effective as compared to usual care over 12 months. The FSM intervention is potentially a promising intervention for chronic fatigue patients in primary care. Additional research is needed to examine the reproducibility and generalizability of these findings.

Trial registration: ClinicalTrials.gov (NCT00997451, March 28, 2009).

Show MeSH
Related in: MedlinePlus