Cost-effectiveness of interventions for medically unexplained symptoms: A systematic review.
Wortman, Margreet S H, Lokkerbol, Joran, van der Wouden, Johannes C et al. · PloS one · 2018 · DOI
Quick Summary
This study looked at 39 research projects to find out which treatments for long-lasting unexplained symptoms—including chronic fatigue syndrome—work best and offer good value for money. The researchers found that group-based treatments (where patients meet together) tend to be more cost-effective than one-on-one treatments. However, the studies they reviewed were quite different from each other, making it hard to compare results directly.
Why It Matters
This systematic review synthesizes economic evidence on symptom management interventions relevant to ME/CFS, showing that group-based treatments may offer better value to healthcare systems and patients. Understanding which interventions are cost-effective is critical for patients and healthcare providers making treatment decisions with limited resources.
Observed Findings
Thirteen of twenty-two cost-utility analyses found interventions were cost-effective (cost per QALY below €50,000 threshold or dominant over control conditions)
Group interventions for MUS (3 studies) and fibromyalgia (4 studies) showed potentially greater cost-effectiveness than individual interventions
Studies were highly heterogeneous in patient populations, intervention types, study designs, and outcome measures
Total of 39 studies met inclusion criteria out of 1,613 articles screened
Most cost-effectiveness analyses focused on fibromyalgia, IBS, and undifferentiated MUS rather than CFS specifically
Inferred Conclusions
Group-based interventions may represent more cost-effective treatment approaches than individual interventions for patients with medically unexplained symptoms and functional somatic syndromes
Heterogeneous study methods and populations limit the strength of conclusions and direct comparability across interventions
Higher-quality, standardized economic evaluations are needed to provide clearer guidance on cost-effective treatment strategies
Remaining Questions
Which specific group intervention components drive cost-effectiveness, and are these components replicable across different healthcare settings?
What This Study Does Not Prove
This study does not prove that group interventions are universally superior—the finding of greater cost-effectiveness is preliminary given study heterogeneity and may not apply to all patient subgroups or healthcare systems. The review does not establish efficacy or safety of any specific intervention, only economic efficiency relative to comparators. Results depend heavily on how each study measured costs and quality of life, which varied considerably.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →