Severens, J L, Prins, J B, van der Wilt, G J et al. · QJM : monthly journal of the Association of Physicians · 2004 · DOI
This study compared the cost and effectiveness of cognitive behaviour therapy (CBT), support groups, and usual care for ME/CFS patients over 14 months. CBT helped more patients improve (27% at 14 months) compared to support groups (11%) and usual care (20%), and was less expensive than support groups. However, compared to doing nothing special, CBT cost about €20,500 per patient who showed meaningful improvement.
Understanding the real-world costs and benefits of treatments is crucial for patients and healthcare systems deciding whether to invest in CBT for ME/CFS. This study provides rare economic data showing that while CBT is more effective than support groups, the overall cost-effectiveness remains uncertain, highlighting the need for longer-term follow-up and better understanding of indirect costs like lost productivity.
This study does not prove that CBT is the best treatment for all ME/CFS patients or that it should be universally funded; the high cost-effectiveness ratios and substantial uncertainty suggest the evidence is mixed. It also does not establish that CBT is suitable for all ME/CFS subtypes, as case definitions and patient heterogeneity may limit generalizability. The study cannot determine causality between CBT and improvement versus natural recovery or placebo effects.
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
Severens, J L, Prins, J B, van der Wilt, G J, van der Meer, J W M, & Bleijenberg, G (2004). Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome.. QJM : monthly journal of the Association of Physicians. https://doi.org/10.1093/qjmed/hch029
BibTeX
@article{mecfsatlas-severens-2004-cost-effectiveness,
author = {Severens, J L and Prins, J B and van der Wilt, G J and van der Meer, J W M and Bleijenberg, G},
title = {Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome.},
journal = {QJM : monthly journal of the Association of Physicians},
year = {2004},
doi = {10.1093/qjmed/hch029},
note = {PubMed: 14976272},
url = {https://www.mecfsatlas.com/evidence/severens-2004-cost-effectiveness},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/severens-2004-cost-effectiveness
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