Medical Costs in Chronic Fatigue Syndrome (CFS): A Sample of Registry-Based Cases Open Access

Abstract

Chronic fatigue syndrome (CFS) is a complex and deliberating chronic illness that affects at
least 4 million people in the United States. Evaluating and assessing the economic impact of
CFS will prove crucial in shaping future policies for clinical research, health institutions, and
education in order to reduce the burden of disease. The objective of this study analysis is to
estimate the medical costs among CFS patients identified from a registry pilot study in
primary and tertiary healthcare settings as well as CFS patients identified from a self-referred
support group between September 2008 and March 2010 in Georgia, USA.

Participants completed a clinical evaluation to confirm CFS diagnosis and to identify other
illnesses. Socio-demographic information including economic data and healthcare utilization
was also collected. We estimated the effect of CFS on direct medical costs that included
inpatient hospitalizations, provider encounter visits, over-the-counter medications, and other
health care costs by stratifying on primary factor-referral status (n = 35) from Bibb County,
Georgia and Macon City, Georgia. Linear regression models using Ordinary Least Squares
were employed to adjust medical costs and earnings for confounders (age, sex, race, marital
status, education, working status, healthcare coverage, and unmet need).

Provider-referred CFS patients had mean annual direct medical costs of $2,462 after
adjusting for potential confounders. After adjustment, sex was found to be statistically
significant in the other health costs category (p=0.04). Additionally, unmet need was found
to be statistically significant in both the total annual healthcare expenditures and provider
encounter visits categories (p=0.02, p=0.04, respectively). Similarly, educational status was
found to be statistically significant in both the total annual healthcare expenditures and
provider encounter visits categories (p=0.03, p=0.03, respectively).

These study results demonstrate that CFS may lead to considerable increases in medical
costs. There is no known cure for CFS; therefore, treatment and management is long-term
and the associated costs may be incurred over decades or even a lifetime. Lastly, this study
may offer unique insight via the perspective of a clinical registry sample population.

Table of Contents

Table of Contents

BACKGROUND ........................................................................................................................................... 1
METHODS ..................................................................................................................................................... 5
RESULTS ....................................................................................................................................................... 14
DISCUSSION ............................................................................................................................................... 18
CONCLUSION ............................................................................................................................................ 24
REFERENCES ............................................................................................................................................. 25
FIGURES ....................................................................................................................................................... 29
TABLES ......................................................................................................................................................... 30
ANNOTATED SAS CODE ...................................................................................................................... 37

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Chronic Fatigue Syndrome, CFS, economic impact, direct costs
Committee Chair / Thesis Advisor	Sullivan, Patrick S, Emory University
Committee Members	Lin, Jin-Mann, CDC
Partnering Agencies	CDC

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