Cost-effectiveness of cognitive behavioural and personalised exercise interventions for reducing fatigue in inflammatory rheumatic diseases

Huey Yi Chong; Paul McNamee; Eva-Maria Bachmair; Kathryn Martin; Lorna Aucott; Neeraj Dhaun; Emma Dures; Richard Emsley; Stuart R. Gray; Elizabeth Kidd; Vinod Kumar; Karina Lovell; Graeme MacLennan; John Norrie; Lorna Paul; Jonathan Packham; Stuart H. Ralston; Stefan Siebert; Alison Wearden; LIFT study group; Gary Macfarlane; Neil Basu

doi:10.1093/rheumatology/kead157

Cost-effectiveness of cognitive behavioural and personalised exercise interventions for reducing fatigue in inflammatory rheumatic diseases

Huey Yi Chong (Lead / Corresponding author), Paul McNamee, Eva-Maria Bachmair, Kathryn Martin, Lorna Aucott, Neeraj Dhaun, Emma Dures, Richard Emsley, Stuart R. Gray, Elizabeth Kidd, Vinod Kumar, Karina Lovell, Graeme MacLennan, John Norrie, Lorna Paul, Jonathan Packham, Stuart H. Ralston, Stefan Siebert, Alison Wearden, LIFT study groupGary Macfarlane, Neil Basu

Undergraduate Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: To estimate the cost-effectiveness of a Cognitive Behavioural Approach (CBA) or a Personalised Exercise Programme (PEP), alongside usual care (UC), in patients with Inflammatory Rheumatic Diseases who report chronic, moderate to severe, fatigue.

Methods: A within-trial cost-utility analysis, was conducted using individual patient data collected within a multicentre, three-arm randomised controlled trial over a 56-week period. The primary economic analysis was conducted from the UK National Health Service (NHS) perspective. Uncertainty was explored using cost-effectiveness acceptability curves and sensitivity analysis.

Results: Complete-case analysis showed that, compared with UC, both PEP and CBA were more expensive [adjusted mean cost difference: PEP £569 (95%CI £464 to £665), CBA £845 (95%CI £717 to £993)] and, in the case of PEP, significantly more effective [adjusted mean QALY difference: PEP 0.043 (95% CI 0.019-0.068), CBA 0.001 (95% CI -0.022-0.022)]. These led to an incremental cost-effectiveness ratio (ICER) of £13 159 for PEP vs. UC, and £793 777 for CBA vs. UC). Non-parametric bootstrapping showed that, at a threshold value of £20 000 per QALY gained, PEP had a probability of 88% of being cost-effective. In multiple imputation analysis, PEP was associated with significant incremental costs of £428 (95% CI £324 to £511) and a non-significant QALY gain of 0.016 (95% CI -0.003-0.035), leading to an ICER of £26 822 vs. UC. The estimates from sensitivity analyses were consistent with these results.

Conclusion: The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.

Original language	English
Journal	Rheumatology
Early online date	5 Apr 2023
DOIs	https://doi.org/10.1093/rheumatology/kead157
Publication status	E-pub ahead of print - 5 Apr 2023

Keywords

cost-effectiveness
cognitive behavioural
personalised exercise
inflammatory rheumatic diseases
fatigue
remote delivery

Access to Document

10.1093/rheumatology/kead157Licence: CC BY-NC

Cite this

Chong, H. Y., McNamee, P., Bachmair, E-M., Martin, K., Aucott, L., Dhaun, N., Dures, E., Emsley, R., Gray, S. R., Kidd, E., Kumar, V., Lovell, K., MacLennan, G., Norrie, J., Paul, L., Packham, J., Ralston, S. H., Siebert, S., Wearden, A., ... Basu, N. (2023). Cost-effectiveness of cognitive behavioural and personalised exercise interventions for reducing fatigue in inflammatory rheumatic diseases. Rheumatology. https://doi.org/10.1093/rheumatology/kead157

@article{8c8ee4c3e5c341439e1d8cd940c20083,

title = "Cost-effectiveness of cognitive behavioural and personalised exercise interventions for reducing fatigue in inflammatory rheumatic diseases",

abstract = "Objectives: To estimate the cost-effectiveness of a Cognitive Behavioural Approach (CBA) or a Personalised Exercise Programme (PEP), alongside usual care (UC), in patients with Inflammatory Rheumatic Diseases who report chronic, moderate to severe, fatigue.Methods: A within-trial cost-utility analysis, was conducted using individual patient data collected within a multicentre, three-arm randomised controlled trial over a 56-week period. The primary economic analysis was conducted from the UK National Health Service (NHS) perspective. Uncertainty was explored using cost-effectiveness acceptability curves and sensitivity analysis.Results: Complete-case analysis showed that, compared with UC, both PEP and CBA were more expensive [adjusted mean cost difference: PEP £569 (95%CI £464 to £665), CBA £845 (95%CI £717 to £993)] and, in the case of PEP, significantly more effective [adjusted mean QALY difference: PEP 0.043 (95% CI 0.019-0.068), CBA 0.001 (95% CI -0.022-0.022)]. These led to an incremental cost-effectiveness ratio (ICER) of £13 159 for PEP vs. UC, and £793 777 for CBA vs. UC). Non-parametric bootstrapping showed that, at a threshold value of £20 000 per QALY gained, PEP had a probability of 88% of being cost-effective. In multiple imputation analysis, PEP was associated with significant incremental costs of £428 (95% CI £324 to £511) and a non-significant QALY gain of 0.016 (95% CI -0.003-0.035), leading to an ICER of £26 822 vs. UC. The estimates from sensitivity analyses were consistent with these results.Conclusion: The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.",

keywords = "cost-effectiveness, cognitive behavioural, personalised exercise, inflammatory rheumatic diseases, fatigue, remote delivery",

author = "Chong, {Huey Yi} and Paul McNamee and Eva-Maria Bachmair and Kathryn Martin and Lorna Aucott and Neeraj Dhaun and Emma Dures and Richard Emsley and Gray, {Stuart R.} and Elizabeth Kidd and Vinod Kumar and Karina Lovell and Graeme MacLennan and John Norrie and Lorna Paul and Jonathan Packham and Ralston, {Stuart H.} and Stefan Siebert and Alison Wearden and {LIFT study group} and Gary Macfarlane and Neil Basu",

note = "Funding Information: This work was supported by Versus Arthritis (formerly Arthritis Research UK) grant number 21175. Copyright: {\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.",

year = "2023",

month = apr,

day = "5",

doi = "10.1093/rheumatology/kead157",

language = "English",

journal = "Rheumatology",

issn = "1462-0324",

publisher = "Oxford University Press",

}

Chong, HY, McNamee, P, Bachmair, E-M, Martin, K, Aucott, L, Dhaun, N, Dures, E, Emsley, R, Gray, SR, Kidd, E, Kumar, V, Lovell, K, MacLennan, G, Norrie, J, Paul, L, Packham, J, Ralston, SH, Siebert, S, Wearden, A, LIFT study group, Macfarlane, G & Basu, N 2023, 'Cost-effectiveness of cognitive behavioural and personalised exercise interventions for reducing fatigue in inflammatory rheumatic diseases', Rheumatology. https://doi.org/10.1093/rheumatology/kead157

TY - JOUR

T1 - Cost-effectiveness of cognitive behavioural and personalised exercise interventions for reducing fatigue in inflammatory rheumatic diseases

AU - Chong, Huey Yi

AU - McNamee, Paul

AU - Bachmair, Eva-Maria

AU - Martin, Kathryn

AU - Aucott, Lorna

AU - Dhaun, Neeraj

AU - Dures, Emma

AU - Emsley, Richard

AU - Gray, Stuart R.

AU - Kidd, Elizabeth

AU - Kumar, Vinod

AU - Lovell, Karina

AU - MacLennan, Graeme

AU - Norrie, John

AU - Paul, Lorna

AU - Packham, Jonathan

AU - Ralston, Stuart H.

AU - Siebert, Stefan

AU - Wearden, Alison

AU - LIFT study group

AU - Macfarlane, Gary

AU - Basu, Neil

N1 - Funding Information: This work was supported by Versus Arthritis (formerly Arthritis Research UK) grant number 21175. Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.

PY - 2023/4/5

Y1 - 2023/4/5

N2 - Objectives: To estimate the cost-effectiveness of a Cognitive Behavioural Approach (CBA) or a Personalised Exercise Programme (PEP), alongside usual care (UC), in patients with Inflammatory Rheumatic Diseases who report chronic, moderate to severe, fatigue.Methods: A within-trial cost-utility analysis, was conducted using individual patient data collected within a multicentre, three-arm randomised controlled trial over a 56-week period. The primary economic analysis was conducted from the UK National Health Service (NHS) perspective. Uncertainty was explored using cost-effectiveness acceptability curves and sensitivity analysis.Results: Complete-case analysis showed that, compared with UC, both PEP and CBA were more expensive [adjusted mean cost difference: PEP £569 (95%CI £464 to £665), CBA £845 (95%CI £717 to £993)] and, in the case of PEP, significantly more effective [adjusted mean QALY difference: PEP 0.043 (95% CI 0.019-0.068), CBA 0.001 (95% CI -0.022-0.022)]. These led to an incremental cost-effectiveness ratio (ICER) of £13 159 for PEP vs. UC, and £793 777 for CBA vs. UC). Non-parametric bootstrapping showed that, at a threshold value of £20 000 per QALY gained, PEP had a probability of 88% of being cost-effective. In multiple imputation analysis, PEP was associated with significant incremental costs of £428 (95% CI £324 to £511) and a non-significant QALY gain of 0.016 (95% CI -0.003-0.035), leading to an ICER of £26 822 vs. UC. The estimates from sensitivity analyses were consistent with these results.Conclusion: The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.

AB - Objectives: To estimate the cost-effectiveness of a Cognitive Behavioural Approach (CBA) or a Personalised Exercise Programme (PEP), alongside usual care (UC), in patients with Inflammatory Rheumatic Diseases who report chronic, moderate to severe, fatigue.Methods: A within-trial cost-utility analysis, was conducted using individual patient data collected within a multicentre, three-arm randomised controlled trial over a 56-week period. The primary economic analysis was conducted from the UK National Health Service (NHS) perspective. Uncertainty was explored using cost-effectiveness acceptability curves and sensitivity analysis.Results: Complete-case analysis showed that, compared with UC, both PEP and CBA were more expensive [adjusted mean cost difference: PEP £569 (95%CI £464 to £665), CBA £845 (95%CI £717 to £993)] and, in the case of PEP, significantly more effective [adjusted mean QALY difference: PEP 0.043 (95% CI 0.019-0.068), CBA 0.001 (95% CI -0.022-0.022)]. These led to an incremental cost-effectiveness ratio (ICER) of £13 159 for PEP vs. UC, and £793 777 for CBA vs. UC). Non-parametric bootstrapping showed that, at a threshold value of £20 000 per QALY gained, PEP had a probability of 88% of being cost-effective. In multiple imputation analysis, PEP was associated with significant incremental costs of £428 (95% CI £324 to £511) and a non-significant QALY gain of 0.016 (95% CI -0.003-0.035), leading to an ICER of £26 822 vs. UC. The estimates from sensitivity analyses were consistent with these results.Conclusion: The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.

KW - cost-effectiveness

KW - cognitive behavioural

KW - personalised exercise

KW - inflammatory rheumatic diseases

KW - fatigue

KW - remote delivery

U2 - 10.1093/rheumatology/kead157

DO - 10.1093/rheumatology/kead157

M3 - Article

C2 - 37018151

SN - 1462-0324

JO - Rheumatology

JF - Rheumatology

ER -

Cost-effectiveness of cognitive behavioural and personalised exercise interventions for reducing fatigue in inflammatory rheumatic diseases

Abstract

Keywords

Access to Document

Fingerprint

Cite this