title: Cost-effectiveness of supported self-management for CFS/ME patients in primary care.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  The trial registration number is IRCTN74156610.
authors: Centre for Health Economics, University of York, Hull/York Medical School,York YO10 5DD, United Kingdom.
authors: Gerry
authors: G
authors: Richardson
authors: David
authors: D
authors: Epstein
authors: Carolyn
authors: C
authors: Chew-Graham
authors: Christopher
authors: C
authors: Dowrick
authors: Richard P
authors: RP
authors: Bentall
authors: Richard K
authors: RK
authors: Morriss
authors: Sarah
authors: S
authors: Peters
authors: Lisa
authors: L
authors: Riste
authors: Karina
authors: K
authors: Lovell
authors: Graham
authors: G
authors: Dunn
authors: Alison J
authors: AJ
authors: Wearden
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000704:Analysis of Variance; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics*; D004739:England; D015673:Fatigue Syndrome, Chronic / Q000191:economics* / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics*; D016037:Single-Blind Method; D012890:Sleep; D016896:Treatment Outcome; D055815:Young Adult