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

Chong, H. Y. et al. (2023) Cost-effectiveness of cognitive behavioural and personalised exercise interventions for reducing fatigue in inflammatory rheumatic diseases. Rheumatology, 62(12), pp. 3819-3827. (doi: 10.1093/rheumatology/kead157) (PMID:37018151)

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 multicentre, 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 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 0.019–0.068), 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 to £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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Norrie, Prof John and Basu, Professor Neil and Gray, Professor Stuart and Siebert, Professor Stefan and Bachmair, Dr Eva-Maria and Paul, Dr Lorna
• Authors: Chong, H. Y., McNamee, P., Bachmair, E.-M., Martin, K., Aucott, L., Dhaun, N., Dures, E., Emsley, R., Gray, S. R., Kidd, E., Kumar, V., Lovell, K., MacLennan, G., Norrie, J., Paul, L., Packham, J., Ralston, S. H., Siebert, S., Wearden, A., LIFT study group, , Macfarlane, G., and Basu, N.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: Rheumatology
• Publisher: Oxford University Press
• ISSN: 1462-0324
• ISSN (Online): 1462-0332
• Published Online: 05 April 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Rheumatology 62(12):3819–3827
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
174167		The LIFT Trial - Lessening the Impact of Fatigue: Therapies for inflammatory rheumatic diseases	Stuart Gray	Versus Arthritis (ARTRESUK)	21175	Institute of Cardiovascular & Medical Sciences