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Cost-effectiveness of counselling, graded-exercise and usual care for chronic fatigue: evidence from a randomised trial in primary care

Ramon Sabes-Figuera1*, Paul McCrone1, Mike Hurley2, Michael King3, Ana Nora Donaldson4 and Leone Ridsdale5

Author Affiliations

1 Centre for the Economics of Mental and Physical Health (CEMPH), Institute of Psychiatry, King’s College London, London, UK

2 Academic Department of Physiotherapy, Health and Social Care Research Division, King’s College London, London, UK

3 Department of Mental Health Sciences, Hampstead Campus, University College London, London, UK

4 Dental Institute, King’s College London, London, UK

5 Unit of Neurology and General Practice, Department of Clinical Neuroscience, Institute of Psychiatry, King’s College London, London, UK

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BMC Health Services Research 2012, 12:264  doi:10.1186/1472-6963-12-264

Published: 20 August 2012



Fatigue is common and has been shown to result in high economic costs to society. The aim of this study is to compare the cost-effectiveness of two active therapies, graded-exercise (GET) and counselling (COUN) with usual care plus a self-help booklet (BUC) for people presenting with chronic fatigue.


A randomised controlled trial was conducted with participants consulting for fatigue of over three months’ duration recruited from 31 general practices in South East England and allocated to one of three arms. Outcomes and use of services were assessed at 6-month follow-up. The main outcome measure used in the economic evaluation was clinically significant improvements in fatigue, measured using the Chalder fatigue scale. Cost-effectiveness was assessed using the net-benefit approach and cost-effectiveness acceptability curves.


Full economic and outcome data at six months were available for 163 participants; GET = 51, COUN = 58 and BUC = 54. Those receiving the active therapies (GET and COUN) had more contacts with care professionals and therefore higher costs, these differences being statistically significant. COUN was more expensive and less effective than the other two therapies. The incremental cost-effectiveness ratio of GET compared to BUC was equal to £987 per unit of clinically significant improvement. However, there was much uncertainty around this result.


This study does not provide a clear recommendation about which therapeutic option to adopt, based on efficiency, for patients with chronic fatigue. It suggests that COUN is not cost-effective, but it is unclear whether GET represents value for money compared to BUC.

Clinical Trial Registration number at ISRCTN register: 72136156

Chronic fatigue; Cost-effectiveness; Randomised controlled trial