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

Research output: Contribution to journalArticlepeer-review


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 languageEnglish
Early online date5 Apr 2023
Publication statusE-pub ahead of print - 5 Apr 2023


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


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