چکیده (انگلیسی):

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 evidencethat 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).