Model-based economic evaluation of non-pharmacological interventions for fatigue in patients with long-term medical conditions in the UK

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 in patients with long-term medical conditions.

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

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 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 cognitive behavioural therapy (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 There remains uncertainty regarding which intervention is most cost-effective due to limitations in the underlying evidence base. Future research is recommended to compare the cost-effectiveness of these interventions across a broad population with different chronic conditions.