“Brain training is most cost-effective treatment for chronic fatigue syndrome,” BBC News reports, while pacing therapies (learning to live within limits) “offer little value”.
Chronic fatigue syndrome (CFS) is a poorly understood and often controversial condition. The most common symptom of CFS is extreme tiredness (fatigue).
This news is based on research that aimed to determine how cost-effective four treatment options were for people with CFS. These were:
To determine the cost-effectiveness, three main factors were taken into account:
Based on the statistical models used by the researchers, CBT and graded exercise therapy were found to be most cost-effective, while specialist medical care and pacing were the least cost-effective.
The researchers did not consider patient preference, which could have an impact.
While patients may well benefit from CBT and exercise therapy, the researchers note that there needs to be investment to ensure properly trained staff are available to deliver them. This study supports the case for this training.
The study was carried out by researchers from King’s College London, Oxford University, London School of Economics and other institutions. It was funded by the UK Medical Research Council, the Department of Health, the Department for Work and Pensions and the Scottish Chief Scientist Office of the Scottish Government Health Directorates.
The study was published in the peer-reviewed journal PLoS ONE.
The coverage by the BBC News was appropriate, though it is unclear how the “millions of pounds” they say the economy could save from wide adoption of these treatments was derived. The term "brain training" used in the headline could give the misleading impression that people with CFS were given computer games consoles to play, but that was not what was looked at in this research.
This was a cost-effectiveness study based on the results of previous research (the PACE trial) that investigated the effectiveness of four treatment options for patients with CFS.
A cost-effectiveness study models the expected total costs of different treatments or interventions (in this case interventions for chronic fatigue syndrome), and compares the effects on health outcomes, to assess which treatments or interventions can be considered to give the best “value for money”. This is usually done from the perspective of the health service. In this case societal costs such as lost employment and the cost of informal care for people affected by the illness were included. This sort of information helps decision-makers decide how best to allocate limited healthcare resources. As this approach takes into account benefits of improvements in health and the savings made from better care, the cheapest treatment option is not necessarily the most cost-effective. It allows different treatments in different diseases to be compared against each other and against society’s willingness to pay for such things.
The researchers used data from a previous study on 640 people with chronic fatigue syndrome. This study compared the effectiveness of adding adaptive pacing therapy, cognitive behavioural therapy or graded exercise therapy to specialist medical care for patients with chronic fatigue syndrome. In this latest study the researchers have investigated the relative cost-effectiveness of these interventions by calculating:
The researchers then compared the:
The number and duration of treatment sessions for each treatment was recorded (with time added for support activities) and the costs per hour of therapy were estimated based on nationally registered sources. Specific types of medication were also included in the analysis and unpaid and informal care from family and friends estimated at £14.60 per hour based on national mean earnings. Days lost by patients from work and reduced hours due to fatigue while at work was also recorded. QALYs were calculated from health-related quality of life questionnaires carried out at the beginning of the study (baseline) and throughout the study.
One-year healthcare, informal care and societal costs were compared using statistical modelling and adjustments were made for estimated standard costs.
Earlier findings of the PACE trial were reported by NHS Choices in February 2011.
The researchers report the healthcare and societal findings of this study separately. The findings include the following:
The researchers say that “their study has found that CBT and graded exercise therapy are cost-effective options for treating patients with CFS. However, for patients to benefit from these therapies there needs to be investment to provide the staff trained to deliver them. The findings we report suggest that such investment would be justified in terms of improved quality of life of patients and would actually be cost saving if all costs including societal costs are considered”.
In discussing the research findings, King’s College London health economist Professor Paul McCrone said “there is now a strong case for the NHS to invest in providing these therapies”.
Another of the researchers from Oxford University said “this new evidence should encourage health service commissioners to provide these treatments to all those patients who need them”.
Overall, this study provides evidence to suggest that cognitive behavioural therapy and graded exercise therapy are reasonable value for people with chronic fatigue syndrome. The study does list some points made by the authors that may limit the study findings, including:
Overall, this is important research into a disabling illness. CFS can last for years. It affects between 0.2 and 2.6% of people worldwide and can be highly disruptive to employment and family life. Any treatments that can be proven to help will most likely be welcomed by those affected by the condition.