Richardson, Gerry, Epstein, David, Chew-Graham, Carolyn et al. · BMC family practice · 2013 · DOI
This study tested whether two nurse-led treatments for ME/CFS—pragmatic rehabilitation (exercise-based) and supportive listening (counseling-based)—were worth the cost compared to standard care from a GP. Both nurse-led treatments were more expensive than usual care and did not provide enough additional benefit to justify their cost, though some patients saw short-term fatigue improvements with rehabilitation.
This study addresses a critical gap in ME/CFS management by examining not just clinical effectiveness but cost-effectiveness of commonly proposed treatments. The finding that standard care outperforms expensive nurse-led interventions challenges prevailing treatment recommendations and informs healthcare resource allocation for this often-neglected disease.
This study does not prove that pragmatic rehabilitation or supportive listening are ineffective treatments—only that they may not justify their cost within the healthcare system studied. The results are time-limited to the trial period and may not reflect longer-term outcomes or different healthcare contexts. Short-term fatigue reduction does not necessarily translate to sustained quality-of-life improvement.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Richardson, Gerry, Epstein, David, Chew-Graham, Carolyn, Dowrick, Christopher, Bentall, Richard P, Morriss, Richard K, et al. (2013). Cost-effectiveness of supported self-management for CFS/ME patients in primary care.. BMC family practice. https://doi.org/10.1186/1471-2296-14-12
BibTeX
@article{mecfsatlas-richardson-2013-cost-effectiveness,
author = {Richardson, Gerry and Epstein, David and Chew-Graham, Carolyn and Dowrick, Christopher and Bentall, Richard P and Morriss, Richard K and Peters, Sarah and Riste, Lisa and Lovell, Karina and Dunn, Graham and Wearden, Alison J and FINE Trial Writing group on behalf of the FINE Trial group},
title = {Cost-effectiveness of supported self-management for CFS/ME patients in primary care.},
journal = {BMC family practice},
year = {2013},
doi = {10.1186/1471-2296-14-12},
note = {PubMed: 23327355},
url = {https://www.mecfsatlas.com/evidence/richardson-2013-cost-effectiveness},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/richardson-2013-cost-effectiveness
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