OBJECTIVES: Most children in the UK with chronic fatigue syndrome/ myalgic encephalomyelitis (CFS/ME) do not have local access to specialist support. We assessed the cost-effectiveness, from a UK healthcare perspective, of delivering online cognitive behavioral therapy (CBT) for children with CFS/ME and their parents, compared to online activity management (AM). In addition, we conducted subgroup analyses for children with and without mild/moderate comorbid anxiety/depression. We also assessed cost-effectiveness from a wider perspective incorporating parental/carer and educational costs.

METHODS: We estimated costs and quality-adjusted life years (QALYs) over a 12-month time horizon, using self-report and routinely collected data. Patient-level data were collected alongside the FITNET-NHS randomized controlled trial which compared online CBT with online AM for 314 children aged 11 to 17 years. Cost-effectiveness was evaluated using the net benefit framework and results were interpreted using the UK’s cost-effectiveness thresholds. Cost-effectiveness acceptability curves were used to characterize uncertainty. Additional methodological assumptions were explored through sensitivity analyses.

RESULTS: Online CBT resulted in a small gain in QALYs (0.002, 95%CI -0.040 to 0.045) and substantially higher mean costs (£1,048, 95%CI £625 to £1,470) compared to online AM. The incremental net monetary benefit was estimated to be £-1,002 (95%CI £-2041 to £38) from a health care perspective and £-1,101 (95%CI £-2,910 to £708) from a wider perspective. Together, these results, as well as the results of our uncertainty and sensitivity analyses, indicated online CBT is unlikely to be cost-effective compared to online AM.

CONCLUSIONS: Despite some improvement in physical function at 6 months, online CBT is unlikely to be cost-effective compared to online AM within the first 12 months. Children with CFS/ME experience low health-related quality of life as illustrated in our study. Further research should aim to identify cost-effective strategies to support children with CFS/ ME who do not have local access to specialist support.