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.
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 StatementData 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
- Cognitive behavioural
- Personalised exercise
- Inflammatory Rheumatic Diseases
- Remote delivery