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

• Published in: Rheumatology (Oxford, England) Vol. 62; no. 12; pp. 3819 - 3827
• Main Authors: Chong, Huey Yi, McNamee, Paul, Bachmair, Eva-Maria, Martin, Kathryn, Aucott, Lorna, Dhaun, Neeraj, Dures, Emma, Emsley, Richard, Gray, Stuart R, Kidd, Elizabeth, Kumar, Vinod, Lovell, Karina, MacLennan, Graeme, Norrie, John, Paul, Lorna, Packham, Jonathan, Ralston, Stuart H, Siebert, Stefan, Wearden, Alison, Macfarlane, Gary, Basu, Neil
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.12.2023
• Subjects: Cognition; Cost-Benefit Analysis; Exercise Therapy; Fatigue - etiology; Fatigue - therapy; Humans; Quality-Adjusted Life Years; Rheumatic Diseases; State Medicine; cost-effectiveness; fatigue; cognitive behavioural; inflammatory rheumatic diseases; remote delivery; personalized exercise
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kead157

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.