Cost-effectiveness of cognitive behavioural and personalized exercise interventions for reducing fatigue in inflammatory rheumatic diseases
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 ,   LIFT Study Group, Nicol Amy , Norris Karen , Mann Sandra , Van Lierop Lorna , Gomez Eli , McCurdy Fiona , Findlay Valerie , Hastie Neil , Morgan Eunice , Emmanuel Roselyn , Whibley Daniel , Urquart Aimee , MacPerson Laura , Rowland Janice , Kiddie Gwen , Pankhurst Debbie , Johnstone Paul , Nicholson Hilary , Dunsmore Angela , Knight Alison , Ellis John , Maclean Callum , Crighton Linda , Shearer Cameron , Coyle Judy , Begg Susan , Ackerman Lyndsey , Carnevale Jill , Arbuthnot Samantha , Watters Helen , Dockrell Dervil , Hamilton Debbie , Salutous Dario , Cathcart Susanne , Rimmer Dominic , Hughes Emma , Harvey Juliet , Gillies Mairi , Webster Susan , Milne Leeanne , Semple Gary , Duffy Katharine , Turner Lynne , Alexander John , Innes June , Clark Charlotte , Meek Christine , McKenna Elizabeth , Routledge Christine , Hinchcliffe-Hume Helain , Traianos Emmanuella , Dibnah Beth , Storey David , O’Callaghan Gemma , Baron Jenny Yael , Hunt Sally , Wheat Natalie , Smith Pam , Barcroft Elizabeth Ann , Thompson Amy , Tomlinson Johanne , Barber Jill , MacPerson Gladys , White Peter , Hewlett Sarah 
Published: April 2023

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.