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

Huey Yi Chong* (Corresponding Author), Paul McNamee, Eva-Maria Bachmair, Kathryn Martin, Lorna Aucott, Neeraj Dhaun, Emma Dures, Richard Emsley, Stuart Robert Gray, Elizabeth Kidd, Vinod Kumar, Karina Lovell, Graeme MacLennan, John Norrie, Lorna Paul, Jonathon Packham, Stuart H Ralston, Stefan Siebert, Alison Wearden, Gary MacfarlaneNeil Basu, LIFT study group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.
A within-trial cost-utility analysis, was conducted using individual patient data collected within a multi64 centre, 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
66 cost-effectiveness acceptability curves and sensitivity analysis.

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 to 0.068), CBA 0.001 (95% CI -0.022 to 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 to 0.035), leading to an ICER of £26,822 vs. UC. The estimates from sensitivity analyses were consistent with these results.
The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.
Original languageEnglish
Publication statusAccepted/In press - 27 Feb 2023


  • Cost-effectiveness
  • Cognitive behavioural
  • Personalised exercise
  • Inflammatory Rheumatic Diseases
  • Fatigue
  • Remote delivery


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