Review Cost effectiveness of non-pharmacological interventions for fatigue in patients with long-term conditions: a systematic literature review, 2025 Davis+

[Andy]

ABSTRACT​

Introduction​

We aimed to assess the cost-effectiveness of non-pharmacological interventions for fatigue in patients with chronic conditions in the UK.

Methods​

This systematic review of cost-effectiveness studies aligns with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement. Data sources: Electronic databases and citation searches. Inclusion criteria: Studies including adults with one or more long-term health condition, either physical or mental. Exclusion criteria: Studies associated with cancer, long-COVID, post-viral fatigue, medically unexplained conditions, developmental disorders and injuries. Assessment: A single reviewer completed a two-stage sifting process.

Results​

Four studies met the inclusion criteria. They included patients with either multiple sclerosis or inflammatory rheumatic conditions, and assessed either cognitive behavioral therapy (CBT) or a personalized exercise programme (PEP). CBT was either dominated by usual care or had an incremental cost-effectiveness ratio (ICER) over £30,000. PEP dominated CBT, with the ICER for PEP versus usual care ranging from £13,159 to £35,424.

Conclusions​

The economic literature on this topic is much more limited than the clinical effectiveness literature, both in terms of interventions and populations covered. Future research should focus on a de novo economic evaluation to identify interventions with a high potential to be cost-effective across multiple conditions.

Paywall

 

[Andy]

"Acknowledgements

The authors would like to thank Helen Dawes, Vincent Deary, Julia Newton, Kate Fryer, Samantha McCormick, David Coyle and Shijie Ren who contributed to the design of the research and specification of the review protocol."

 

[Andy]

Some very odd word choice,
"CBT was either dominated by usual care" and "PEP dominated CBT"

Perhaps AI 'helped' out?

 

[Utsikt]

The supplemental materials are available for download. Apparently, one of the studies on PEP (Chong 2023, LIFT RCT) only had results from 42 % of the participants, but that didn’t stop them from rating the study as having «minor limitations».

 

[Sean]

How can a 'treatment' that delivers no practical benefit be cost effective?

 

[rvallee]

Four studies met the inclusion criteria

"Systematic". I guess that's a common synonym for cherry-picking now. The fact that almost every review and analysis either systematically excludes over 95% of studies, or marks them down as too low quality to bother comparing, never bothers anyone, they always conclude the same:

Future research should focus on the de novo economic evaluations using clinical effectiveness data across different chronic conditions to identity interventions with the greatest potential for cost-effectiveness.

"Do more of the same, no one but the patients cares anyway, and those don't matter". So inexplicable how zero progress has ever been made using this methodology.

The methodology cannot fail, it can only be failed, by patients, who either should be listened fully, if they agree with the interventions, or are a bunch of whiny whiners.

 

[rvallee]

How can a 'treatment' that delivers no practical benefit be cost effective?

The main way in which the biological analog "computer" differs from the digital kind: it can happily divide by zero and find zero problem with being stuck in an infinite loop. It just keeps looping and looping and looping forever and ever.