{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T16:19:26Z","timestamp":1782749966371,"version":"3.54.5"},"reference-count":39,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"crossref","award":["NIHR154660"],"award-info":[{"award-number":["NIHR154660"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,31]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent fatigue is a frequent symptom in chronic medical conditions. Systematic reviews of non-pharmacological interventions for fatigue have identified interventions that are effective at reducing fatigue, but there is limited published evidence on the cost-effectiveness of these interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify non-pharmacological fatigue interventions that have the potential to be cost-effective in patients with long-term medical conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Decision analytic modelling with intervention costs estimated from staff time and quality-of-life outcomes mapped from a systematic review and network meta-analysis of fatigue outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>UK National Health Service (NHS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>People with persistent fatigue associated with a chronic medical condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Non-pharmacological fatigue interventions versus usual care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Net monetary benefit from a UK NHS and Personal Social Services perspective; quality-adjusted life years (QALYs) gained; intervention costs valued at 2022\/23 prices; costs and benefits discounted at 3.5% per annum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the base-case analysis, expected costs from the probabilistic analysis for individual and group interventions were: \u00a3267 and \u00a3157 for physical activity promotion, \u00a3810 and \u00a3485 for cognitive behavioural therapy (CBT)-Fatigue and \u00a3462 and \u00a3214 for mindfulness. The expected QALYs gained were similar for mindfulness and physical activity promotion (0.061 and 0.060, respectively), but lower for CBT-Fatigue (0.045). All interventions provided positive incremental net monetary benefit (INMB) versus usual care when valuing a QALY at \u00a320 000. However, since group interventions are less costly than individual ones, and we assumed equivalent clinical benefit, they are expected to provide greater INMB. These findings remained robust across different scenarios, except for CBT-Fatigue (individual), which had negative INMB in some scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There remains uncertainty regarding which intervention is most cost-effective due to limitations in the underlying evidence base. Future research is recommended to compare the cost-effectiveness of these interventions across a broad population with different chronic conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102846","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:05:30Z","timestamp":1777050330000},"page":"e102846","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Model-based economic evaluation of non-pharmacological interventions for fatigue in patients with long-term medical conditions in the UK"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6921-7529","authenticated-orcid":false,"given":"Mon","family":"Mon-Yee","sequence":"first","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0233-2431","authenticated-orcid":false,"given":"Christopher","family":"Burton","sequence":"additional","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5632-6021","authenticated-orcid":false,"given":"Joanna","family":"Leaviss","sequence":"additional","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5839-9160","authenticated-orcid":false,"given":"Jessica E","family":"Forsyth","sequence":"additional","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2367-9584","authenticated-orcid":false,"given":"George","family":"Daly","sequence":"additional","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6609-4287","authenticated-orcid":false,"given":"Sarah","family":"Davis","sequence":"additional","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"2026042410051001000_16.4.e102846.1","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-00337-z","article-title":"Fatigue in patients with chronic disease: results from the population-based Lifelines Cohort Study","volume":"11","author":"Go\u00ebrtz","year":"2021","journal-title":"Sci Rep"},{"key":"2026042410051001000_16.4.e102846.2","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-024-74683-z","article-title":"Comparative study for fatigue prevalence in subjects with diseases: a systematic review and meta-analysis","volume":"14","author":"Park","year":"2024","journal-title":"Sci Rep"},{"key":"2026042410051001000_16.4.e102846.3","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1111\/jnu.12763","article-title":"Prevalence and risk factors of fatigue in type 1 and type 2 diabetes: A systematic review and meta-analysis","volume":"54","author":"Romadlon","year":"2022","journal-title":"J Nurs Scholarsh"},{"key":"2026042410051001000_16.4.e102846.4","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kel021"},{"key":"2026042410051001000_16.4.e102846.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12883-021-02396-1","article-title":"Prevalence and burden of multiple sclerosis-related fatigue: a systematic literature review","volume":"21","author":"Oliva Ramirez","year":"2021","journal-title":"BMC Neurol"},{"key":"2026042410051001000_16.4.e102846.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003954","article-title":"Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis","volume":"19","author":"Fletcher","year":"2022","journal-title":"PLoS Med"},{"key":"2026042410051001000_16.4.e102846.7","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000598"},{"key":"2026042410051001000_16.4.e102846.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2016.02.013"},{"key":"2026042410051001000_16.4.e102846.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2019.12.358"},{"key":"2026042410051001000_16.4.e102846.10","doi-asserted-by":"crossref","unstructured":"Ananthakrishnan AN , Desai R , Lee W-J , et al . 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