Abstract
Purpose :
Previous research has shown that many persons with visual impairment experience severe symptoms of fatigue. We developed an E-health intervention based on cognitive behavioral therapy and self-management, which was supported by social workers from low-vision clinics, with the aim to reduce fatigue severity. In a randomized controlled trial, we investigated its (cost-)effectiveness versus usual care.
Methods :
After the baseline measurement, 98 persons with visual impairment and severe fatigue were either randomized to the ‘E-nergEYEze’ intervention (n=51) or the control group (n=47). Primary outcome was the Checklist Individual Strength-Fatigue Severity (CIS-FS). Secondary outcomes were related to the impact of fatigue, vision loss, depression, anxiety, quality of life (QOL), sleep and work. All outcomes were assessed at baseline, 6 and 12 months by blinded interviewers. Intention-to-treat analyses were carried out with linear mixed models. Cost-effectiveness and cost-utility analyses were performed from a societal perspective.
Results :
Patients in the intervention group showed a substantial reduction of fatigue (CIS-FS) over time compared to controls (mean difference (MD) -5.28; 95% CI -9.06 to -1.50). A reduction of symptoms related to the impact of fatigue, depression, anxiety, insomnia and hypersomnolence was also found in favor of the intervention group, but no clear improvement on the impact of visual impairment, adaptation to vision loss, other sleep or work-related outcomes and quality-adjusted life-years (QALYs). From a societal perspective, E-nergEYEze resulted in higher average costs per person: MD €944 (95% CI -2,068 to 3,956). Incremental cost effectiveness ratios (ICER) were €138,790 per QALY gained and €161 per unit of improvement on the CIS-FS.
Conclusions :
E-nergEYEze offers an effective way of reducing severe fatigue in adults with visual impairment and several other symptoms. Whether it is cost-effective depends on societal willingness to pay for fatigue reduction, which is currently unknown. The intervention does not seem to be cost-effective with regards to QALYs gained, since the ICER is much higher than conventionally applied cost-effectiveness thresholds. This inconsistency could be caused by insensitivity of our QOL instrument to health improvements in this context, or to the relationship between QOL and fatigue.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.