Cost-effectiveness of cognitive behavioural and personalized exercise interventions for reducing fatigue in inflammatory rheumatic diseases
Author:
Chong Huey Yi1ORCID, McNamee Paul1, Bachmair Eva-Maria23, Martin Kathryn4, Aucott Lorna5, Dhaun Neeraj6ORCID, Dures Emma7, Emsley Richard8ORCID, Gray Stuart R9ORCID, Kidd Elizabeth10, Kumar Vinod11, Lovell Karina12, MacLennan Graeme5ORCID, Norrie John13, Paul Lorna14, Packham Jonathan15, Ralston Stuart H16, Siebert Stefan2ORCID, Wearden Alison12, Macfarlane Gary34ORCID, Basu Neil2, Nicol Amy, Norris Karen, Mann Sandra, Van Lierop Lorna, Gomez Eli, McCurdy Fiona, Findlay Valerie, Hastie Neil, Morgan Eunice, Emmanuel Roselyn, Whibley Daniel, Urquart Aimee, MacPerson Laura, Rowland Janice, Kiddie Gwen, Pankhurst Debbie, Johnstone Paul, Nicholson Hilary, Dunsmore Angela, Knight Alison, Ellis John, Maclean Callum, Crighton Linda, Shearer Cameron, Coyle Judy, Begg Susan, Ackerman Lyndsey, Carnevale Jill, Arbuthnot Samantha, Watters Helen, Dockrell Dervil, Hamilton Debbie, Salutous Dario, Cathcart Susanne, Rimmer Dominic, Hughes Emma, Harvey Juliet, Gillies Mairi, Webster Susan, Milne Leeanne, Semple Gary, Duffy Katharine, Turner Lynne, Alexander John, Innes June, Clark Charlotte, Meek Christine, McKenna Elizabeth, Routledge Christine, Hinchcliffe-Hume Helain, Traianos Emmanuella, Dibnah Beth, Storey David, O’Callaghan Gemma, Baron Jenny Yael, Hunt Sally, Wheat Natalie, Smith Pam, Barcroft Elizabeth Ann, Thompson Amy, Tomlinson Johanne, Barber Jill, MacPerson Gladys, White Peter, Hewlett Sarah,
Affiliation:
1. Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen , Aberdeen, UK 2. Institute of Infection, Immunity and Inflammation, University of Glasgow , Glasgow, UK 3. Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen , Aberdeen, UK 4. Aberdeen Centre for Arthritis and Musculoskeletal Health (Academic Primary Care Group), University of Aberdeen , Aberdeen, UK 5. Centre of Healthcare and Randomised Trials (CHaRT), Health Service Research Unit, University of Aberdeen , Aberdeen, UK 6. Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh/British Heart Foundation Centre of Research Excellence , Edinburgh, UK 7. Faculty of Health and Applied Sciences, University of the West of England , Bristol, UK 8. Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London , London, UK 9. Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow , Glasgow, UK 10. Department of Rheumatology, Freeman’s Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne, UK 11. Department of Rheumatology, Ninewells Hospital, NHS Tayside , Dundee, UK 12. School of Health Sciences, University of Manchester , Manchester, UK 13. Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital , Edinburgh, UK 14. School of Health and Life Science, Glasgow Caledonian University , Glasgow, UK 15. Physiotherapy and Paramedicine, Haywood Rheumatology Centre , Stoke-on-Trent, UK 16. Rheumatology and Bone Disease, University of Edinburgh, Western General Hospital , Edinburgh, UK
Abstract
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.
Funder
Versus Arthritis Arthritis Research UK
Publisher
Oxford University Press (OUP)
Subject
Pharmacology (medical),Rheumatology
Cited by
1 articles.
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