Trial reportPloS one2012
Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis.
Trial report in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It has been retracted, and should not be counted. Cited by 39 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
39 citing papers in PubMed, 8 syntheses or guidelines pooled it, 84 citations in OpenAlex.
- Exercise therapy for chronic fatigue syndrome.The Cochrane database of systematic reviews · 2024Pooled it
- A systematic review of economic analyses of psychological interventions and therapies in health-related settings.BMC health services research · 2022Pooled it
- Cost-effectiveness of Interventions for Chronic Fatigue Syndrome or Myalgic Encephalomyelitis: A Systematic Review of Economic Evaluations.Applied health economics and health policy · 2021Pooled it
- The evidence base for physiotherapy in myalgic encephalomyelitis/chronic fatigue syndrome when considering post-exertional malaise: a systematic review and narrative synthesis.Journal of translational medicine · 2021Pooled it
- CBT to reduce healthcare use for medically unexplained symptoms: systematic review and meta-analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Pooled it
- Cost-effectiveness of interventions for medically unexplained symptoms: A systematic review.PloS one · 2018Pooled it
- Exercise therapy for chronic fatigue syndrome.The Cochrane database of systematic reviews · 2017Pooled it
- Exercise therapy for chronic fatigue syndrome.The Cochrane database of systematic reviews · 2016Pooled it
- Comparison of cognitive behaviour therapy versus activity management, both delivered remotely, to treat paediatric chronic fatigue syndrome/myalgic encephalomyelitis: the UK FITNET-NHS RCT.Health technology assessment (Winchester, England) · 2024Trial
- Improving Cost-effectiveness and Access to Cognitive Behavior Therapy for Depression: Providing Remote-Ready, Computer-Assisted Psychotherapy in Times of Crisis and Beyond.Psychotherapy and psychosomatics · 2020Trial
- Rethinking the treatment of chronic fatigue syndrome-a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT.BMC psychology · 2018Trial
- Trial
- A feasibility study of the clinical effectiveness and cost-effectiveness of individual cognitive behavioral therapy for panic disorder in a Japanese clinical setting: an uncontrolled pilot study.BMC research notes · 2016Trial
- Trial
- Cost-effectiveness of supported self-management for CFS/ME patients in primary care.BMC family practice · 2013Trial
- Understanding fatigue severity and smoking deprivation in smoking behavior and urges: A pilot test.Experimental and clinical psychopharmacology · 2025Article
- The PACE Trial's GET Manual for Therapists Exposes the Fixed Incremental Nature of Graded Exercise Therapy for ME/CFS.Life (Basel, Switzerland) · 2025Article
- Fixing science means an end to gaming the system.PLoS biology · 2024Article
- Article
- Trends and Hotspots in the Health Economics Evaluation of Chronic Fatigue Syndrome.Journal of multidisciplinary healthcare · 2024Review
Corrections and comments
- Expression of concern · 2015-12-15Concerns/Issues about Data · Concerns/Issues about Results and/or Conclusions · Investigation by Journal/Publisher · · Editorial note - later upgraded to Expression of Concern;
- Expression of concern · 2017-05-02Concerns/Issues about Data · Concerns/Issues about Results and/or Conclusions · Investigation by Journal/Publisher · Objections by Author(s) · Upgrade/Update of Prior Notice(s) · · See also: http://blogs.plos.org/everyone/2017/05/02/data-sharing-in-clinical-research/ [PLoS editor post]
- Expression of concern
Authors and funding
7 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundThe PACE trial compared the effectiveness of adding adaptive pacing therapy (APT), cognitive behaviour therapy (CBT), or graded exercise therapy (GET), to specialist medical care (SMC) for patients with chronic fatigue syndrome. This paper reports the relative cost-effectiveness of these treatments in terms of quality adjusted life years (QALYs) and improvements in fatigue and physical function.
methodsResource use was measured and costs calculated. Healthcare and societal costs (healthcare plus lost production and unpaid informal care) were combined with QALYs gained, and changes in fatigue and disability; incremental cost-effectiveness ratios (ICERs) were computed.
resultsSMC patients had significantly lower healthcare costs than those receiving APT, CBT and GET. If society is willing to value a QALY at £30,000 there is a 62.7% likelihood that CBT is the most cost-effective therapy, a 26.8% likelihood that GET is most cost effective, 2.6% that APT is most cost-effective and 7.9% that SMC alone is most cost-effective. Compared to SMC alone, the incremental healthcare cost per QALY was £18,374 for CBT, £23,615 for GET and £55,235 for APT. From a societal perspective CBT has a 59.5% likelihood of being the most cost-effective, GET 34.8%, APT 0.2% and SMC alone 5.5%. CBT and GET dominated SMC, while APT had a cost per QALY of £127,047. ICERs using reductions in fatigue and disability as outcomes largely mirrored these findings.
conclusionsComparing the four treatments using a health care perspective, CBT had the greatest probability of being the most cost-effective followed by GET. APT had a lower probability of being the most cost-effective option than SMC alone. The relative cost-effectiveness was even greater from a societal perspective as additional cost savings due to reduced need for informal care were likely.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.