title: Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis.
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.
authors.affiliation: Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom. paul.mccrone@kcl.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe
authors.forename: Trudie
authors.initials: T
authors.lastname: Chalder
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Johnson
authors.forename: Kimberley A
authors.initials: KA
authors.lastname: Goldsmith
authors.forename: Peter D
authors.initials: PD
authors.lastname: White
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods; D003365:Costs and Cost Analysis; D005081:Exercise Therapy / Q000191:economics* / Q000379:methods; D015673:Fatigue Syndrome, Chronic / Q000191:economics* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006113:United Kingdom