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
Number of pages9
Early online date24 Apr 2023
Publication statusE-pub ahead of print - 24 Apr 2023

Bibliographical note

The authors would like to thank all the participants who supported this trial. We acknowledge the contribution of the Trial Steering Committee and Data Monitoring Committee, and Brian Taylor and Mark Forrest (Centre for Healthcare Randomised Trials [CHaRT], University of Aberdeen, Aberdeen, UK) for their technical assistance.

Funding: This work was supported by Versus Arthritis (formerly Arthritis Research UK) grant number 21175.

Data Availability Statement

Data availability statement
Data of anonymised individual patient are available upon reasonable request made to the corresponding author, subject to a data sharing agreement and UK research governance regulations


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


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