Chronic fatigue has high, but mainly hidden, costs
- Brage, Søren MD, PhD
BACKGROUND
People with chronic fatigue and chronic fatigue syndrome depend on informal carers, including family and friends, as well as receiving formal health services, mainly in primary care. The bulk of costs associated with care may not be borne by health services and may, therefore, be underestimated.
OBJECTIVE
To determine the costs of service use and lost employment in caring for people with chronic fatigue and chronic fatigue syndrome.
SETTING
South of England; January 1999 to June 2001.
METHOD
Economic analysis.
PARTICIPANTS
Adults at 22 general practices, with at least a 6-month history of fatigue, with normal blood tests. Patients with another physical or psychiatric diagnosis explaining the fatigue symptoms, or substance abuse, or who were unable to read English, or who were under the care of mental health or physiotherapy professionals, were excluded.
OUTCOMES AND DATA ANALYSIS
Costs included were 3-month use of in-patient and community services (including alternative treatments), number of hours of informal care received (based on the cost of providing these services formally if informal support was not available), costs of medication and lost production (using the human capital approach: time lost from work multiplied by wage rate multiplied by 0.8). Non-prescribed medication and travel time to and at appointments were not included. Multiple regression was used to compare patients with chronic fatigue only with those meeting diagnostic criteria for chronic fatigue syndrome. Non-parametric bootstrapping methods were used to deal with skewed data. Sensitivity analysis was used to assess the impact of changes in underlying cost assumptions.
MAIN RESULTS
Costs of these conditions were appreciable and were higher in patients fulfilling the criteria for chronic fatigue syndrome (see Table 1). Costs were also higher if the patient had dependants (p=0.001), and rose with the level of disability (p=0.008).
AUTHORS' CONCLUSIONS
The costs associated with chronic fatigue are high, but are mainly hidden costs of informal care and lost employment.