Open Access Highly Accessed Open Badges Research article

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

Gerry Richardson1, David Epstein1, Carolyn Chew-Graham2, Christopher Dowrick3, Richard P Bentall4, Richard K Morriss5*, Sarah Peters6, Lisa Riste6, Karina Lovell7, Graham Dunn2, Alison J Wearden6 and the FINE Trial Writing group on behalf of the FINE Trial group

Author affiliations

1 Centre for Health Economics, University of York, Hull/York Medical School, York, YO10 5DD, United Kingdom

2 School of Community Based Medicine, University of Manchester, Manchester, M13 9PL, United Kingdom

3 School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool, L69 3GB, United Kingdom

4 School of Psychology, University of Bangor, Adeilad Brigantia, Penrallt Road, Bangor, Gwynedd, LL57 2AS, United Kingdom

5 School of Community Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, United Kingdom

6 School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom

7 School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9PL, United Kingdom

For all author emails, please log on.

Citation and License

BMC Family Practice 2013, 14:12  doi:10.1186/1471-2296-14-12

Published: 18 January 2013



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.

Trial registration

The trial registration number is IRCTN74156610

Cost-effectiveness; Primary care; CFS/ME; Self-management; Supportive listening; Pragmatic rehabilitation