Economic evaluation of non-pharmacological interventions for fatigue in patients with long-term medical conditions

Background

Persistent fatigue is a frequent symptom in chronic medical conditions. Systematic reviews of non-pharmacological interventions for fatigue have identified interventions that are effective at reducing fatigue, but there is limited published evidence on the cost-effectiveness of these interventions.

Objective

To identify non-pharmacological fatigue interventions that have the potential to be cost-effective and would warrant further investigation in future cost-effectiveness studies.

Design

Decision-analytic modelling with quality-of-life outcomes mapped from a systematic review and network meta-analysis of fatigue outcomes and intervention costs estimated from staff time.

Setting

UK National Health Service (NHS)

Participants

People with persistent fatigue associated with a chronic medical condition

Interventions

Non-pharmacological fatigue interventions versus usual care

Primary and secondary outcome measures

Net monetary benefit from a UK NHS and Personal Social Services (PSS) perspective; quality-adjusted life years (QALYs) gained; intervention costs valued at 2022/23 prices; costs and benefits discounted at 3.5% per annum.

Results

In the base case analysis, expected costs from the probabilistic analysis for individual and group interventions were: £267 and £157 for physical activity promotion, £810 and £485 for CBT-Fatigue, and £462 and £214 for mindfulness. The expected QALYs gained were similar for mindfulness and physical activity promotion (0.061 and 0.060 respectively), but lower for CBT-Fatigue (0.045). All interventions provided positive incremental net monetary benefit (INMB) versus usual care when valuing a QALY at £20,000. However, since group interventions are less costly than individual ones, and we assumed equivalent clinical benefit, they are expected to provide greater INMB. These findings remained robust across different scenarios, except for CBT-Fatigue (individual) which had negative INMB in some scenarios.

Conclusions

CBT-Fatigue, physical activity promotion and mindfulness interventions all demonstrated the potential to be cost-effective versus usual care. Future research is recommended to compare the cost-effectiveness of these interventions across a broad population with different chronic conditions.

STRENGTHS AND LIMITATIONS OF THIS STUDY

• Fatigue outcomes were estimated from a robust systematic review and network analysis that pooled data across studies conducted across multiple chronic conditions, with multiple sclerosis being most common.

• The treatment effects for interventions delivered to groups and individuals are assumed to be similar, but this assumption was only supported by an analysis exploring separate treatment effects for group and individual CBT-Fatigue interventions.

• The results for group physical activity promotion and individual mindfulness interventions should be treated with caution owing to there only being data beyond end of treatment for individual physical activity promotion and group mindfulness interventions.

• Healthcare costs were restricted to staffing costs for delivering the intervention and therefore do not capture any impact on resource use outside of the intervention or any non-staff intervention cost such as access to a specific digital tool.