Cost-effectiveness of the ReDIRECT/counterweight-plus weight management programme to alleviate symptoms of long COVID

Abstract

Long-term effects of COVID-19 infection, termed Long COVID (LC), are associated with reduced quality of life. Symptoms associated with overweight/obesity overlap with and may aggravate those of LC. This paper reports the economic evaluation alongside the ReDIRECT Trial, which evaluated the impact of an evidence-based, remotely-delivered weight management programme on self-reported symptoms of LC in those living with overweight/obesity in the United Kingdom. Recruited participants (n = 234) were randomly allocated to the intervention group (weight management) or control group (usual care). Incremental costs and Quality-Adjusted Life Years (QALYs) were calculated using intervention cost, healthcare resource use and EQ-5D-5L data collected at baseline, three and 6 months. In this work, we show that the ReDIRECT intervention is likely cost-effective in improving LC symptoms from an NHS/PSS perspective, compared to usual care (Incremental Cost-Effectiveness Ratio of £14,754/QALY). Adopting a broader societal perspective, the intervention becomes potentially cost saving compared to usual care.

Fig. 1. Utility score from EQ5D questionnaire by trial arm at baseline, 3 months, and 6 months after randomisation.

a Line graph showing mean utility score by trial arm, with standard error shading (n = 118 control, n = 116 intervention), and b box plot showing the distribution of utility scores by trial arm over the trial period (n = 118 control, n = 116 intervention). The box plots show the median (centre line), the first and third quartiles (the lower and upper bounds of the box), and the whiskers show 1.5× the interquartile range. Points beyond the whiskers are ‘outlying’ points plotted individually. Source data are provided with this paper.

Fig. 2. Healthcare resource utilisation by trial arm at baseline, 3 months, and 6 months after randomisation.

a shows the mean resource use per participant over the trial period, by trial arm, with standard error shading (n = 118 control, n = 116 intervention); b shows box plots of the distribution of resource use costs among participants over the trial period, by trial arm (n = 118 control, n = 116 intervention). The box plots show the median (centre line), the first and third quartiles (the lower and upper bounds of the box), and the whiskers show 1.5× the interquartile range. Points beyond the whiskers are ‘outlying’ points plotted individually. c is a bar chart showing resource use category cost drivers over the trial period, by trial arm (n = 118 control, n = 116 intervention). Source data are provided with this paper.

Fig. 3. Hours of work missed due to sickness by trial arm, at baseline, 3 months, and 6 months after randomisation (n = 118 control, n = 116 intervention).

a Bar chart showing the total number of hours of work missed, by trial arm; b line graph showing mean number of hours of work missed per participant, by trial arm, with standard error shading. Source data are provided with this paper.

Fig. 4. Incremental cost-effectiveness ratio (ICER) Planes and cost-effectiveness acceptability curves (CEACs) for the National Health Service and Personal Social Services (NHS/PSS) and societal perspectives using 5000 non-parametric bootstrap replicates on 10 imputed datasets from an original sample of n = 234 individuals (n = 118 control, n = 116 intervention).

Each individual had three scheduled observations, with a total of 37/702 missing observations (1/354 missing observation in the control arm, 36/348 missing observations in the intervention arm). a ICER Plane from the NHS/PSS perspective. b CEAC from the NHS/PSS perspective. c ICER Plane from the societal perspective. d CEAC Plane from the societal perspective. QALY: Quality-adjusted life year.