Open Access Open Badges Research article

Implementing cognitive behavior therapy for chronic fatigue syndrome in mental health care: a costs and outcomes analysis

Korine Scheeres1*, Michel Wensing2, Gijs Bleijenberg1 and Johan L Severens34

Author affiliations

1 Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre (4628), PO Box 9101, 6500 HB, The Netherlands

2 Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, The Netherlands

3 Department of Health Organization, Policy and Economics, Maastricht University, The Netherlands

4 Department of Clinical Epidemiology and MTA, University Hospital Maastricht, The Netherlands

For all author emails, please log on.

Citation and License

BMC Health Services Research 2008, 8:175  doi:10.1186/1472-6963-8-175

Published: 13 August 2008



This study investigated the costs and outcomes of implementing cognitive behavior therapy (CBT) for chronic fatigue syndrome (CFS) in a mental health center (MHC). CBT is an evidence-based treatment for CFS that was scarcely available until now. To investigate the possibilities for wider implementation, a pilot implementation project was set up.


Costs and effects were evaluated in a non-controlled before- and after study with an eight months time-horizon. Both the costs of performing the treatments and the costs of implementing the treatment program were included in the analysis. The implementation interventions included: informing general practitioners (GPs) and CFS patients, training therapists, and instructing the MHC employees. Given the non-controlled design, cost outcome ratios (CORs) and their acceptability curves were analyzed. Analyses were done from a health care perspective and from a societal perspective. Bootstrap analyses were performed to estimate the uncertainty around the cost and outcome results.


125 CFS patients were included in the study. After treatment 37% had recovered from CFS and the mean gained QALY was 0.03. Costs of patients' health care and productivity losses had decreased significantly. From the societal perspective the implementation led to cost savings and to higher health states for patients, indicating dominancy. From the health care perspective the implementation revealed overall costs of €5.320 per recovered patient, with an acceptability curve showing a 100% probability for a positive COR at a willingness to pay threshold of €6.500 per recovered patient.


Implementing CBT for CFS in a MHC appeared to have a favorable cost outcome ratio (COR) from a societal perspective. From a health care perspective the COR depended on how much a recovered CFS patient is being valued. The strength of the evidence was limited by the non-controlled design. The outcomes of this study might facilitate health care providers when confronted with the decision whether or not to adopt CBT for CFS in their institution.