Chisholm D, Godfrey E, Ridsdale L, Chalder T, King M, Seed P, Wallace P, Wessely S
Department of Neurology, King's College of Medicine, London.
Br J Gen Pract. 2001 Jan;51(462):15-8.
There is a paucity of evidence relating to the cost-effectiveness of alternative treatment responses to chronic fatigue.
To compare the relative costs and outcomes of counselling versus cognitive behaviour therapy (CBT) provided in primary care settings for the treatment of fatigue.
A randomised controlled trial incorporating a cost-consequences analysis.
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.
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 was the Fatigue Questionnaire; secondary measures were the Hospital Anxiety and Depression Scale and a social adjustment scale.
Although the mean cost of treatment was higher for the CBT group (164 Pounds, standard deviation = 67) than the counselling group (109 Pounds, 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).
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.
关于慢性疲劳替代治疗反应的成本效益的证据匮乏。
比较在初级保健机构中提供的咨询与认知行为疗法（CBT）治疗疲劳的相对成本和结果。
一项纳入成本后果分析的随机对照试验。
来自伦敦和南泰晤士地区10家全科诊所的129名患者，他们经历疲劳症状至少三个月。
进行经济分析以衡量治疗成本、其他卫生服务利用、非正式护理和失业成本。主要结局指标是疲劳问卷；次要指标是医院焦虑抑郁量表和社会适应量表。
尽管CBT组的平均治疗成本（164英镑，标准差=67）高于咨询组（109英镑，标准差=49；95%置信区间=35至76，P<0.001），但基线与六个月评估之间的变化分数比较显示，两组在总医疗保健成本、患者和家庭成本或增量成本效益（疲劳评分每改善单位的成本）方面无统计学显著差异。
咨询和CBT均能改善疲劳及相关症状，同时略微降低非正式护理和生产力损失成本。咨询是成本较低（且更广泛可用）的干预措施，但两种治疗形式均未发现总体成本效益优势。
