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Randomized Controlled Trial
. 2023 Dec 1;62(12):3819-3827.
doi: 10.1093/rheumatology/kead157.

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

Huey Yi Chong  1 , Paul McNamee  1 , Eva-Maria Bachmair  2   3 , Kathryn Martin  4 , Lorna Aucott  5 , Neeraj Dhaun  6 , Emma Dures  7 , Richard Emsley  8 , Stuart R Gray  9 , Elizabeth Kidd  10 , Vinod Kumar  11 , Karina Lovell  12 , Graeme MacLennan  5 , John Norrie  13 , Lorna Paul  14 , Jonathan Packham  15 , Stuart H Ralston  16 , Stefan Siebert  2 , Alison Wearden  12 , Gary Macfarlane  3   4 , Neil Basu  2 ; LIFT Study Group
Collaborators, Affiliations
Randomized Controlled Trial

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

Huey Yi Chong et al. Rheumatology (Oxford). .

Abstract

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.

Keywords: cognitive behavioural; cost-effectiveness; fatigue; inflammatory rheumatic diseases; personalized exercise; remote delivery.

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Figures

Figure 1.
Figure 1.
Cost-effectiveness acceptability curves of base case analysis (NHS perspective). CBA: cognitive behavioural approach; NHS: National Health Service; PEP: personalized exercise programme; QALY: quality-adjusted life year; UC: usual practice
See this image and copyright information in PMC

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