TY - JOUR
T1 - Cost-effectiveness of cognitive behavioural and personalized 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 - Macfarlane, Gary
AU - Basu, Neil
AU - LIFT study group
N1 - Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - OBJECTIVES: To estimate the cost-effectiveness of a cognitive behavioural approach (CBA) or a personalized 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 randomized 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, £665); CBA £845 (95% CI: £717, £993)] and, in the case of PEP, significantly more effective [adjusted mean quality-adjusted life year (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, £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 personalized 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 randomized 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, £665); CBA £845 (95% CI: £717, £993)] and, in the case of PEP, significantly more effective [adjusted mean quality-adjusted life year (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, £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 - cognitive behavioural
KW - cost-effectiveness
KW - fatigue
KW - inflammatory rheumatic diseases
KW - personalized exercise
KW - remote delivery
UR - http://www.scopus.com/inward/record.url?scp=85178651263&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/kead157
DO - 10.1093/rheumatology/kead157
M3 - Article
C2 - 37018151
SN - 1462-0324
VL - 62
SP - 3819
EP - 3827
JO - Rheumatology
JF - Rheumatology
IS - 12
ER -