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Cited by 12Health Systems, Economic Evaluations, Quality of LifeFibromyalgia and Chronic Fatigue Syndrome ResearchMusculoskeletal pain and rehabilitation

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

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Meng, Hongdao, Friedberg, Fred, Castora-Binkley, Melissa·2014·BMC Family Practice
DOI 10.1186/s12875-014-0184-7PMC PMC4260238
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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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  • Psychological functioning was measured using the Beck Depression Inventory (BDI) and Beck Depression Inventory-II (BDI-II) scale in eight studies.

    “Psychological functioning was measured using the Beck Depression Inventory (BDI) and Beck Depression Inventory-II (BDI-II) scale [124] in eight studies”

    From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [108]

    The Methods > Outcome measures section identifies the Fatigue Severity Scale as this trial’s primary outcome measure, but does not mention the BDI or BDI-II. Searches for those inventories and for psychological-functioning measures found no passage in our copy supporting their use or the count of eight studies. No page numbers are available in our copy. (LLM, conf=0.74)

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  • Friedberg et al.'s chronic fatigue self-management intervention revealed no significant changes in SF-36PF scores by time, treatment group, or diagnostic group (p>0.05).

    “No significant changes in scores by time, treatment group, or diagnostic group were revealed (p>0.05)”

    From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [108]

    The Methods (Outcome measures; page not provided) identify the Fatigue Severity Scale, not SF-36PF, as this paper’s primary outcome. The Results (Sample characteristics; page not provided) report FSS changes, but the searched passages do not report SF-36PF scores or tests by time, treatment group, and diagnostic group (searched: SF-36PF and physical functioning). (LLM, conf=0.76)

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  1. [1]Whiting P Bagnall AM Sowden AJ Cornell JE Mulrow CD Ramirez G Interventions for the treatment and management of chronic fatigue syndrome: a systematic review JAMA 2001 286 11 1360 1368 10.1001/jama.286.11.1360 11560542 · DOI · Paper page
  2. [2]Burns D Chronic fatigue syndrome or myalgic encephalomyelitis Nurs Stand 2012 26 25 48 56 10.7748/ns2012.02.26.25.48.c8950 22455228 · DOI
  3. [4]Kroenke K Wood DR Mangelsdorff AD Meier NJ Powell JB Chronic fatigue in primary care. Prevalence, patient characteristics, and outcome JAMA 1988 260 7 929 934 10.1001/jama.1988.03410070057028 3398197 · DOI
  4. [5]Assefi NP Coy TV Uslan D Smith WR Buchwald D Financial, occupational, and personal consequences of disability in patients with chronic fatigue syndrome and fibromyalgia compared to other fatiguing conditions J Rheumatol 2003 30 4 804 808 12672203
  5. [6]Friedberg F Chronic fatigue syndrome, fibromyalgia, and related illnesses: a clinical model of assessment and intervention J Clin Psychol 2010 66 6 641 665 20186721
  6. [7]Jason LA Taylor RR Kennedy CL Song S Johnson D Torres S Chronic fatigue syndrome: occupation, medical utilization, and subtypes in a community-based sample J Nerv Ment Dis 2000 188 9 568 576 10.1097/00005053-200009000-00002 11009329 · DOI
  7. [8]McCrone P Darbishire L Ridsdale L Seed P The economic cost of chronic fatigue and chronic fatigue syndrome in UK primary care Psychol Med 2003 33 2 253 261 10.1017/S0033291702006980 12622304 · DOI
  8. [9]Price JR Mitchell E Tidy E Hunot V Cognitive behaviour therapy for chronic fatigue syndrome in adults Cochrane Database Syst Rev 2008 3 18646067 PMC7028002
  9. [11]Collin SM Crawley E May MT Sterne JA Hollingworth W The impact of CFS/ME on employment and productivity in the UK: a cross-sectional study based on the CFS/ME national outcomes database BMC Health Serv Res 2011 11 217 10.1186/1472-6963-11-217 21923897 PMC3184626 · DOI
  10. [13]Moss-Morris R Sharon C Tobin R Baldi JC A randomized controlled graded exercise trial for chronic fatigue syndrome: outcomes and mechanisms of change J Health Psychol 2005 10 2 245 259 10.1177/1359105305049774 15723894 · DOI
  11. [14]Chambers D Bagnall AM Hempel S Forbes C Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review J R Soc Med 2006 99 10 506 520 10.1258/jrsm.99.10.506 17021301 PMC1592057 · DOI
  12. [15]O’Dowd H Gladwell P Rogers CA Hollinghurst S Gregory A Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group programme Health Technol Assess 2006 10 37 iii iv 17014748
  13. [16]Twisk FN Maes M A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS Neuro Endocrinol Lett 2009 30 3 284 299 19855350
  14. [17]Chisholm D Godfrey E Ridsdale L Chalder T King M Seed P Wallace P Wessely S Chronic fatigue in general practice: economic evaluation of counselling versus cognitive behaviour therapy Br J Gen Pract 2001 51 462 15 18 11271867 PMC1313893
  15. [18]McCrone P Ridsdale L Darbishire L Seed P Cost-effectiveness of cognitive behavioural therapy, graded exercise and usual care for patients with chronic fatigue in primary care Psychol Med 2004 34 6 991 999 10.1017/S0033291704001928 15554570 · DOI
  16. [19]Severens JL Prins JB van der Wilt GJ van der Meer JW Bleijenberg G Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome QJM 2004 97 3 153 161 10.1093/qjmed/hch029 14976272 · DOI
  17. [20]Sabes-Figuera R McCrone P Hurley M King M Donaldson AN Ridsdale L Cost-effectiveness of counselling, graded-exercise and usual care for chronic fatigue: evidence from a randomised trial in primary care BMC Health Serv Res 2012 12 264 10.1186/1472-6963-12-264 22906319 PMC3480915 · DOI
  18. [21]Yates BT Toward the incorporation of costs, cost-effectiveness analysis, and cost-benefit analysis into clinical research J Consult Clin Psychol 1994 62 4 729 736 10.1037/0022-006X.62.4.729 7962876 · DOI
  19. [22]Doshi JA Glick HA Polsky D Analyses of cost data in economic evaluations conducted alongside randomized controlled trials Value Health 2006 9 5 334 340 10.1111/j.1524-4733.2006.00122.x 16961551 · DOI
  20. [25]Schulz KF Altman DG Moher D CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials Ann Intern Med 2010 152 11 726 732 10.7326/0003-4819-152-11-201006010-00232 20335313 · DOI · Paper page
  21. [27]Krupp LB LaRocca NG Muir-Nash J Steinberg AD The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus Arch Neurol 1989 46 10 1121 1123 10.1001/archneur.1989.00520460115022 2803071 · DOI · Paper page
  22. [28]Taylor RR Jason LA Torres A Fatigue rating scales: an empirical comparison Psychol Med 2000 30 4 849 856 10.1017/S0033291799002500 11037093 · DOI
  23. [29]Gold M Siegel J Russell L Weinstein M Cost-Effectiveness in Health and Medicine 1996 New York, New York Oxford University Press
  24. [31]Goossens MEJB Rutten-Van Mölken MPMH Kole-Snijders AMJ Vlaeyen JWS Van Breukelen G Leidl R Health economic assessment of behavioural rehabilitation in chronic low back pain: a randomised clinical trial Health Econ 1998 7 1 39 51 10.1002/(SICI)1099-1050(199802)7:1<39::AID-HEC323>3.0.CO;2-S 9541083 · DOI
  25. [32]Glick HA Doshi JA Sonnad SS Polsky D Economic Evaluation in Clinical Trials 2007 New York Oxford University Press
  26. [33]Oostenbrink JB Koopmanschap MA Rutten FF Standardisation of costs: the Dutch Manual for Costing in economic evaluations PharmacoEconomics 2002 20 7 443 454 10.2165/00019053-200220070-00002 12093300 · DOI
  27. [34]Manning WG Mullahy J Estimating log models: to transform or not to transform? J Health Econ 2001 20 4 461 494 10.1016/S0167-6296(01)00086-8 11469231 · DOI
  28. [35]Drummond M Sculpher M Torrance G O’Brien B Stoddart G Methods for the Economic Evaluation of Health Care Programmes 2005 3 New York, NY Oxford University Press
  29. [36]Mooney CZ Bootstrap statistical inference: examples and evaluations for political science Am J Polit Sci 1996 40 2 570 602 10.2307/2111639 · DOI
  30. [37]Briggs AH O’Brien BJ Blackhouse G Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies Annu Rev Public Health 2002 23 377 401 10.1146/annurev.publhealth.23.100901.140534 11910068 · DOI
  31. [38]Stinnett AA Mullahy J The negative side of cost-effectiveness analysis JAMA 1997 277 24 1931 1932 10.1001/jama.1997.03540480031023 9200628 · DOI
  32. [39]Briggs AH A Bayesian approach to stochastic cost-effectiveness analysis. An illustration and application to blood pressure control in type 2 diabetes Int J Technol Assess Health Care 2001 17 1 69 82 10.1017/S0266462301104071 11329846 · DOI
  33. [40]Richardson G Epstein D Chew-Graham C Dowrick C Bentall RP Morriss RK Peters S Riste L Lovell K Dunn G Wearden AJ FINE Trial Writing group on behalf of the FINE Trial group Cost-effectiveness of supported self-management for CFS/ME patients in primary care BMC Fam Pract 2013 14 12 10.1186/1471-2296-14-12 23327355 PMC3556109 · DOI
  34. [42]Fleming TR Addressing missing data in clinical trials Ann Intern Med 2011 154 2 113 117 10.7326/0003-4819-154-2-201101180-00010 21242367 PMC3319761 · DOI
  35. [43]Ramsey S Willke R Briggs A Brown R Buxton M Chawla A Cook J Glick H Liljas B Petitti D Reed S Good research practices for cost-effectiveness analysis alongside clinical trials: the ISPOR RCT-CEA Task Force report Value Health 2005 8 5 521 533 10.1111/j.1524-4733.2005.00045.x 16176491 · DOI

Cited by

Sorted by citations

Authors
Meng, H., Friedberg, F., & Castora-Binkley, M.
Affiliations
University of South Florida (US)
Corresponding author
Meng, Hongdao
ORCID
Venue
BMC Family Practice
Publisher
Springer Science and Business Media LLC
Published
2014-11-25
Volume
15
Issue
1
Pages
184-184
ISSN
1471-2296 (ISSN-L)
DOI
10.1186/s12875-014-0184-7
PMC
PMC4260238
OpenAlex
W2061649809
Cited by
12
References
5
Citations by year
2020: 2 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 2 · 2015: 1
FWCI
4.14
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Family Practice (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute of Nursing Research (R01NR010229)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
chronic fatigue, fatigue self-management, cognitive behavioral therapy, cost-effectiveness, primary care, nurse-led intervention, self-help books, health care expenditure, Fatigue Severity Scale, net monetary benefit, incremental cost-effectiveness ratio
MeSH terms
Adolescent, Adult, Aged, Cost-Benefit Analysis, Health Expenditures, Female, Health Services, Humans, Male, Middle Aged, Pilot Projects, Self Care, Fatigue Syndrome, Chronic, Cognitive Behavioral Therapy, Health Care Costs, Young Adult

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