Abstract
Objectives
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.
Methods
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.
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 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.
Conclusion
The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.
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.
Methods
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.
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 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.
Conclusion
The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.
| Original language | English |
|---|---|
| Journal | Rheumatology |
| Publication status | Accepted/In press - 27 Feb 2023 |
Keywords
- Cost-effectiveness
- Cognitive behavioural
- Personalised exercise
- Inflammatory Rheumatic Diseases
- Fatigue
- Remote delivery