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

Chong, Huey Yi; McNamee, Paul; Bachmair, Eva Maria; Martin, Kathryn; Aucott, Lorna; Dhaun, Neeraj; Dures, Emma; Emsley, Richard; Gray, Stuart; Kidd, Elizabeth; Kumar, Vinod; Lovell, Karina; Maclennan Msc, Graeme; Norrie, John; Paul, Lorna; Packham, Jon; Ralston, Stuart H; Siebert, Stefan; Wearden, Alison; Macfarlane Phd, Gary; Basu, Neil

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.

• Journal Article Type: Article
• Acceptance Date: Feb 27, 2023
• Online Publication Date: Apr 5, 2023
• Publication Date: Dec 31, 2023
• Deposit Date: Mar 9, 2023
• Publicly Available Date: Dec 8, 2023
• Journal: Rheumatology (Oxford, England)
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 62
• Issue: 12
• Pages: 3819-3827
• DOI: https://doi.org/10.1093/rheumatology/kead157
• Keywords: Diseases, Fatigue, Remote delivery, Cost-effectiveness, Cognitive Behavioural, Personalised Exercise, Inflammatory Rheumatic
• Public URL: https://uwe-repository.worktribe.com/output/10488821