Comment on: Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome. [QJM. 2004]
Sir,
I read Severens et al.’s article on the cost-effectiveness of cognitive behaviour therapy for patients with unexplained chronic fatigue1 with interest, although as several subjects met the CDC criteria for ‘idiopathic chronic fatigue’ rather than ‘chronic fatigue syndrome’,2,,3 I prefer to use the term ‘unexplained chronic fatigue’ as defined by Fukuda et al.3 to describe the patient sample under consideration.
To be able to regard the presented cost estimates as a valid reflection of the medical costs of patients with unexplained chronic fatigue, it is imperative to demonstrate that there are no differences between participants who are included in the analysis and participants who are excluded from the analysis.
According to the authors: ‘An extensive comparison between participants in the cost-effectiveness analyse (n = 171) and the remaining clinical study participants (n = 99) did not reveal any statistically significant differences regarding age, duration of CFS complaints, and scores for Sickness Impact Profile, Karnofsky score, physical activity, a self-efficacy scale, a causal attribution list, and functional impairment.’ (pp. 158–9).
Although details are lacking in the article, baseline data of the included and excluded participants are available from a publication of the Health Care Insurance Board of the Netherlands (College voor zorgverzekeringen).4 Comparing baseline variables of the two groups using two-tailed independent sample t-tests yields the results that are presented in Table 1. The table shows that physical activity (measured by a motion-sensing device called the actometer), self-efficacy, and psychological well-being (measured by the symptom checklist 90) are significantly different at the 0.05 level. The p values for physical activity (p = 0.0081) and self-efficacy (p = 0.0046) are particularly small.
You can read the rest of this comment here: http://qjmed.oxfordjournals.org/content/97/6/379.long
Source: Stouten B. Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome. QJM. 2004 Jun;97(6):379-80. http://qjmed.oxfordjournals.org/content/97/6/379.long (Full article)