Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2012;7(8):e40808.
doi: 10.1371/journal.pone.0040808. Epub 2012 Aug 1.

Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis

Paul McCrone  1 , Michael Sharpe, Trudie Chalder, Martin Knapp, Anthony L Johnson, Kimberley A Goldsmith, Peter D White
Affiliations
Clinical Trial

Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis

Paul McCrone et al. PLoS One. 2012.

Expression of concern in

Abstract

Background: The PACE trial compared the effectiveness of adding adaptive pacing therapy (APT), cognitive behaviour therapy (CBT), or graded exercise therapy (GET), to specialist medical care (SMC) for patients with chronic fatigue syndrome. This paper reports the relative cost-effectiveness of these treatments in terms of quality adjusted life years (QALYs) and improvements in fatigue and physical function.

Methods: Resource use was measured and costs calculated. Healthcare and societal costs (healthcare plus lost production and unpaid informal care) were combined with QALYs gained, and changes in fatigue and disability; incremental cost-effectiveness ratios (ICERs) were computed.

Results: SMC patients had significantly lower healthcare costs than those receiving APT, CBT and GET. If society is willing to value a QALY at £30,000 there is a 62.7% likelihood that CBT is the most cost-effective therapy, a 26.8% likelihood that GET is most cost effective, 2.6% that APT is most cost-effective and 7.9% that SMC alone is most cost-effective. Compared to SMC alone, the incremental healthcare cost per QALY was £18,374 for CBT, £23,615 for GET and £55,235 for APT. From a societal perspective CBT has a 59.5% likelihood of being the most cost-effective, GET 34.8%, APT 0.2% and SMC alone 5.5%. CBT and GET dominated SMC, while APT had a cost per QALY of £127,047. ICERs using reductions in fatigue and disability as outcomes largely mirrored these findings.

Conclusions: Comparing the four treatments using a health care perspective, CBT had the greatest probability of being the most cost-effective followed by GET. APT had a lower probability of being the most cost-effective option than SMC alone. The relative cost-effectiveness was even greater from a societal perspective as additional cost savings due to reduced need for informal care were likely.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: PDW has done voluntary and paid consultancy work for the United Kingdom Departments of Health and Work and Pensions and Swiss Re (a reinsurance company), and led a randomised controlled trial about graded exercise therapy funded by the Linbury Trust. TC has received royalties from Sheldon Press and Constable and Robinson. MS has done voluntary and paid consultancy work for the United Kingdom government, has done consultancy work for the insurance company Aegon and has received royalties from Oxford University Press. PM, ALJ, KAG, and MK declare that they have no conflicts of interests. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. QALY-based cost-effectiveness acceptability curves (healthcare perspective).
Figure 2
Figure 2. QALY-based cost-effectiveness acceptability curves (societal perspective).
See this image and copyright information in PMC

References

    1. Prins JB, van der Meer JW, Bleijenberg G (2006) Chronic fatigue syndrome. Lancet 367: 346–355. - PubMed
    1. McCrone P, Darbishire D, Ridsdale L, Seed P (2003) The economic cost of chronic fatigue and chronic fatigue syndrome in UK primary care. Psychol Med 33: 253–261. - PubMed
    1. Collin SM, Crawley E, May MT, Sterne JAC, Hollingworth W (2011) The impact of CFS/ME on employment and productivity in the UK: a cross-sectional study based on the CFS/ME National Outcomes Database. BMC Health Serv Res 11. (217). - PMC - PubMed
    1. National Institute for Health and Clinical Excellence (2007) Clinical guideline CG53. Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management. Available: http://guidance.nice.org.uk/CG53. Accessed 2010 Nov 6.
    1. White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, et al. (2011) Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 377: 823–836. - PMC - PubMed