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Cost-effectiveness of supported self-management for CFS/ME patients in primary care

Richardson, Gerry; Epstein, David; Chew-Graham, Carolyn; Dowrick, Christopher; Bentall, Richard P.; Morriss, Richard K.; Peters, Sarah; Riste, Lisa; Lovell, Karina; Dunn, Graham; Wearden, Alison J.


Gerry Richardson

David Epstein

Carolyn Chew-Graham

Christopher Dowrick

Richard P. Bentall

Richard K. Morriss

Sarah Peters

Lisa Riste

Karina Lovell

Graham Dunn

Alison J. Wearden



Nurse led self-help treatments for people with chronic fatigue syndrome/myalgic encephalitis (CFS/ME) have been shown to be effective in reducing fatigue but their cost-effectiveness is unknown.

Cost-effectiveness analysis conducted alongside a single blind randomised controlled trial comparing pragmatic rehabilitation (PR) and supportive listening (SL) delivered by primary care nurses, and treatment as usual (TAU) delivered by the general practitioner (GP) in North West England. A within trial analysis was conducted comparing the costs and quality adjusted life years (QALYs) measured within the time frame of the trial. 296 patients aged 18 and over with CFS/ME diagnosed using the Oxford criteria were included in the cost-effectiveness analysis.

Treatment as usual is less expensive and leads to better patient outcomes compared with Supportive Listening. Treatment as usual is also less expensive than Pragmatic Rehabilitation. PR was effective at reducing fatigue in the short term, but the impact of the intervention on QALYs was uncertain. However, based on the results of this trial, PR is unlikely to be cost-effective in this patient population.

This analysis does not support the introduction of SL. Any benefits generated by PR are unlikely to be of sufficient magnitude to warrant recommending PR for this patient group on cost-effectiveness grounds alone. However, dissatisfaction with current treatment options means simply continuing with ‘treatment as usual’ in primary care is unlikely to be acceptable to patients and practitioners.


Richardson, G., Epstein, D., Chew-Graham, C., Dowrick, C., Bentall, R. P., Morriss, R. K., …Wearden, A. J. (2013). Cost-effectiveness of supported self-management for CFS/ME patients in primary care. BMC Family Practice, 14(Januar), doi:10.1186/1471-2296-14-12

Journal Article Type Article
Publication Date Jan 18, 2013
Deposit Date Apr 8, 2014
Publicly Available Date Apr 8, 2014
Journal BMC Family Practice
Electronic ISSN 1471-2296
Publisher Humana Press
Peer Reviewed Peer Reviewed
Volume 14
Issue Januar
Article Number 9
Keywords Cost-effectiveness, Primary care, CFS/ME, Self-management, Supportive listening, Pragmatic rehabilitation
Public URL
Publisher URL


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