Q J Med 2004; 97: 153-161
QJM vol. 97 no. 3 (c) Association of Physicians 2004; all rights reserved.
Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome
From the 1Department of Medical Technology Assessment, University Medical Centre Nijmegen, 2Department of Health Organization, Policy, and Economics, University of Maastricht, and Departments of 3Medical Psychology and 4Internal Medicine, and 5Expert Centre Chronic Fatigue, University Medical Centre Nijmegen, The Netherlands
Received 14 October 2003 and in revised form 23 December 2003
Background: There is some evidence that cognitive behaviour therapy (CBT) is efficacious in chronic fatigue syndrome (CFS), but little data on its cost-effectiveness.
Design: Prospective economic analysis alongside a randomized clinical trial.
Methods: CFS patients were randomly assigned to CBT, guided support groups (SG), or the ‘natural course’ (NC, no protocol-based interventions). Patients were treated for 8 months and followed-up for another 6 months. Costs per patient showing clinically significant improvement, based on the CIS fatigue scale, and costs per quality-adjusted life year, were determined for a time period of 14 months.
Results: Data were available for 171 patients at 8 months and for 128 at 14 months. At 8 and 14 months, the percentages of improved patients were 31% and 27% for CBT, 9% and 11% for SG, and 12% and 20% for NC. Mean QALYs gained at 14 months were, for CBT, SG and NC, respectively, 0.0737, -0.0018 and 0.0458. CBT and SG mean treatment costs were 
1490 and 424. Other medical costs for CBT, SG, and NC, respectively, were 324, 623 and 412 for the first period, and 232, 561 and 378 for the second period. Non-medical costs for these periods for CBT, SG and NC were 262, 550, 427 and 226, 439, 287, respectively. Productivity costs were considerable, but not significantly different between groups.
Discussion: CBT was less costly and more effective than SG. Compared to NC, the baseline incremental cost-effectiveness of CBT was 20 516 per CFS patient showing clinically significant improvement, and 21 375 per QALY. The bootstrap ratios showed considerable uncertainty regarding the results. Future research should focus on productivity costs, and follow patients prospectively over a longer period.
Address correspondence to Dr J.L. Severens, Dept of Health Organisation, Policy, and Economics, University Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands. e-mail: h.severens{at}beoz.unimaas.nl