Evidence Quality and Limitations

The intervention cost estimates included staffing only and excluded downstream resource changes, adverse effects, and digital tool costs. The network meta-analysis rated clinical effectiveness evidence as moderate for physical activity promotion and low for CBT-Fatigue and mindfulness. The model assumed group and individual interventions had equivalent clinical efficacy. The apparent QALY advantage of physical activity promotion and mindfulness over CBT-Fatigue should not be interpreted as evidence of clinical superiority across diverse chronic conditions. The Goodwin et al. mapping algorithm was developed in a multiple sclerosis cohort, so its generalisability to other chronic conditions is uncertain. Wide confidence intervals on intervention costs make head-to-head INMB comparisons uncertain. The study did not recommend disinvestment in CBT-Fatigue because long-term evidence for physical activity promotion and mindfulness was thin and uncertainty across conditions remained.