Chronic fatigue in general practice: economic evaluation of counselling versus cognitive behaviour therapy

Background: There is a paucity of evidence relating to the cost-effectiveness of alternative treatment responses to chronic fatigue. Aim: To compare the relative costs and outcomes of counselling versus cognitive behaviour therapy (CBT) provided in primacy care settings for the treatment of fatigue. Design of study: A randomised controlled trial incorporating a cost-consequences analysis. Setting: One hundred and twenty-nine patients from 10 general practices across London and the South Thames region who had experienced symptoms of fatigue for at least three months. Method: An economic analysis was performed to measure costs of therapy, other use of health services, informal care-giving; and lost employment. The principal outcome measure war the Fatigue Questionnaire; secondary measures were the Hospital Anxiety and Depression Scale and a social adjustment scale. Results: Although the mean cost of treatment was higher for the CBT group (pound 164, standard deviation = 67) than the counselling group (pound 109, SD = 49; 95% confidence interval = 35 to 76, P<0.001), a comparison of change scores between baseline and six-month assessment revealed no statistically significant differences between the two groups in terms of aggregate health care costs, patient and family costs or incremental cost-effectiveness (cost per unit of improvement on the fatigue score). Conclusions: Counselling and CBT both led to improvements in fatigue and related symptoms, while slightly reducing informal care and lost productivity costs. Counselling represents a less costly (and more widely available) intervention but no overall cost-effectiveness advantage was found for either form of therapy.