The hidden cost of chronic fatigue to patients and their families

Centre for the Economics of Mental Health, Health Services Research Department, Institute of Psychiatry, King's College, London, UK.
BMC Health Services Research (Impact Factor: 1.71). 03/2010; 10(1):56. DOI: 10.1186/1472-6963-10-56
Source: PubMed


Nearly 1 in 10 in the population experience fatigue of more than six months at any one time. Chronic fatigue is a common reason for consulting a general practitioner, and some patients report their symptoms are not taken seriously enough. A gap in perceptions may occur because doctors underestimate the impact of fatigue on patients' lives. The main aim of the study is to explore the economic impact of chronic fatigue in patients seeking help from general practitioners and to identify characteristics that explain variations in costs.
The design of study was a survey of patients presenting to general practitioners with unexplained chronic fatigue. The setting were 29 general practice surgeries located in the London and South Thames regions of the English National Health Service. Use of services over a six month period was measured and lost employment recorded. Regression models were used to identify factors that explained variations in these costs.
The mean total cost of services and lost employment across the sample of 222 patients was 3878 pounds for the six-month period. Formal services accounted for 13% of this figure, while lost employment accounted for 61% and informal care for 26%. The variation in the total costs was significantly related to factors linked to the severity of the condition and social functioning.
The economic costs generated by chronic fatigue are high and mostly borne by patients and their families. Enquiry about the functional consequences of fatigue on the social and occupational lives of patients may help doctors understand the impact of fatigue, and make patients feel better understood.

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Available from: Ana Nora Alix Donaldson
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    • "Chronic fatigue syndrome (CFS) or myalgic encephalitis (ME) is characterized by severe, disabling, medically unexplained fatigue that is not alleviated by rest and lasts for at least 6 months [Tables 1 and 2].[12] CFS/ME causes high levels of disability and burden to affected individuals, families, and society; and is associated with high economic costs in the UK.[34] The National Institute for Clinical Excellence (NICE) guideline for CFS/ME in England for CFS/ME emphasizes the importance of confident diagnosis in primary care, starting treatment early, and working in partnership with people with CFS/ME to manage the condition.[2] "
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    ABSTRACT: Chronic fatigue syndrome/myalgic encephalitis (CFS/ME) is rarely diagnosed in South Asia (SA), although the symptoms of this condition are seen in the population. Lessons from UK based South Asian, Black and Minority Ethnic (BME) communities may be of value in identifying barriers to diagnosis of CFS/ME in SA. To explore why CFS/ME may not be commonly diagnosed in SA. A secondary analysis of qualitative data on the diagnosis and management of CFS/ME in BME people of predominantly South Asian origin in the UK using 27 semi-structured qualitative interviews with people with CFE/ME, carers, general practitioners (GPs), and community leaders. CFS/ME is seen among the BME communities in the UK. People from BME communities in the UK can present to healthcare practitioners with vague physical complaints and they can hold a biomedical model of illness. Patients found it useful to have a label of CFS/ME although some GPs felt it to be a negative label. Access to healthcare can be limited by GPs reluctance to diagnose CFS/ME, their lack of knowledge and patients negative experiences. Cultural aspects among BME patients in the UK also act as a barrier to the diagnosis of CFS/ME. Cultural values and practices influence the diagnosis of CFS/ME in BME communities. The variations in the perceptions around CFS/ME among patients, carers, and health professionals may pose challenges in diagnosing CFS/ME in SA as well. Raising awareness of CFS/ME would improve the diagnosis and management of patients with CFS/ME in SA.
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    • "Exclusion and inclusion criteria of the clinical trial have been described elsewhere [2,8]. Briefly, participants were patients presenting to their general practitioners (GPs) complaining of fatigue with a duration of more than three months. "
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    ABSTRACT: 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.
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    • "That women and younger people are less likely to discontinue work is consistent with findings from a US community-based study [13]. A UK-based study of patients presenting with chronic fatigue in a primary care setting reported that loss of employment over the preceding 6-month period had a mean cost per person of £2,350 (95% CI £1734 - £2966) although it is unclear whether all of these patients had CFS/ME [27]. The equivalent cost from our data (based on the weighted average of half the mean annual income) would be £5,753. "
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