OP0343-HPR An economic evaluation of a tailored guided internet-based cognitive behavioural intervention for patients with rheumatoid arthritisas an addition to usual care
Authors: M. Ferwerda, S. van Beugen, H. van Middendorp, H. Visser, H. Vonkeman, M. Creemers, P. van Riel, W. Kievit, A. Evers
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Within the field of rheumatoid arthritis (RA), patients report decreased health-related quality of life (HRQoL) as a result of living with physical factors such as pain and psychological factors such as negative mood. As these factors are associated with the disease trajectory, health care utilisation, and workplace disability of patients, these factors lead to significant societal health expenses. In a recent randomised controlled trial, improvements in especially psychological functioning (e.g., depressed mood) were found by offering tailored, therapist guided cognitive behavioural therapy online.<sup>1</sup> Although internet-based cognitive behavioural therapy holds promise for implementation and cost-reductions, scarce research is available on the cost-effectiveness of these treatments. <h3>Objectives</h3> A cost-effectiveness study from a societal perspective was conducted alongside a randomised controlled trial on a tailored and therapist-guided internet-based cognitive behavioural intervention (ICBT) for patients with elevated levels of distress, as an addition to usual care alone in order to inform stake-holders on implementation of this treatment. <h3>Methods</h3> Data were collected at baseline/pre-intervention, 6 months/post-intervention, and three-monthly thereafter during one year follow-up. Effects were measured in quality-adjusted life years (QALYs) and costs from a societal perspective including healthcare sector costs (including healthcare use, medication, and intervention costs), patient travel costs for healthcare use, and costs associated with loss of labour. <h3>Results</h3> The intervention improved quality of life compared to usual care alone (Δ QALYs=0.059), but also led to higher costs (Δ=€ 4.211,44), which reduced substantially when medication costs were left out of the equation (Δ=€ 1.862,72). Most (93%) of the simulated ICERS were in the north-east quadrant, suggesting a high probability that the intervention is effective in improving HRQoL, but at a greater monetary cost for society compared to usual care alone. <h3>Conclusions</h3> A positive effect on quality-adjusted life years is seen in the intervention group compared to the control group. However, cost-ratios show that this comes at a greater cost to society. The substantial costs in this population are generated by medication costs, for which no group differences could be found. The cost-benefit ratio improves when the costs for medication are not taken into account. Based on the effects for improvement of quality of life, implementation of the intervention is recommended, yet on the side of costs, further study is warranted. <h3>Reference</h3> [1] Ferwerda M, van Beugen S, van Middendorp H, Spillekom-van Koulil S, Donders ART, Visser H, Taal E, Creemers MCW, van Riel PCLM, Evers AWM. A tailored-guided internet-based cognitive-behavioural intervention for patients with rheumatoid arthritis as an adjunct to standard rheumatological care: Results of a randomized controlled trial. Pain2017;158(5):868–78. PMID: 28106666 <h3>Disclosure of Interest</h3> None declared