Healthcare Outcome Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark.
RMD Open. 2022 Jul;8(2). doi: 10.1136/rmdopen-2022-002304.
The aim of this study was to evaluate the cost-effectiveness of an individually tailored intervention consisting of motivational counselling and text message reminders to reduce sedentary behaviour in comparison with usual lifestyle in patients with rheumatoid arthritis (RA).
RA patients (n=150) were randomised to the intervention or control group. Costs of the intervention and healthcare utilisation during a 22-month follow-up period were reported. Outcomes were objectively measured as 24 hours/7 days sitting time and self-reported Health Assessment Questionnaire (HAQ) and EQ-5D scores at baseline, and 16 weeks, 10 and 22 months after baseline. Cost-effectiveness was reported as incremental cost-effectiveness ratios and statistical uncertainty presented as cost-effectiveness acceptability curves.
The intervention cost was estimated at €387 per participant. The mean incremental 22-month healthcare cost was €-1165 (95% bootstrap CI -5613 to 3283). An incremental 20%-point of the participants (CI 10.4% to 29.6%) reduced their daily sitting time more than 50 min and 36%-point reported better HAQ scores (change>0.22). The time-weighted health utilities (quality-adjusted life years (QALYs)) increased by 0.10 (CI 0.02 to 0.18) and 0.11 (CI 0.04 to 0.19) for EQ-5D index and EQ-VAS, respectively. The intervention dominated usual lifestyle by offering better outcomes and lower costs. With a threshold value of €30 000/QALY the intervention has a probability of 95% of being cost-effective.
This protocolised cost-effectiveness analysis showed that an individually tailored intervention aimed at reducing sedentary behaviour in patients with RA is improving participants' 22-month health status and reducing healthcare costs. These results suggest that the intervention should be implemented in routine rheumatology care.
NCT01969604.
本研究旨在评估一项个体化定制干预措施（包括动机咨询和短信提醒以减少类风湿关节炎患者的久坐行为）的成本效益，与常规生活方式相比。
将 150 例 RA 患者随机分为干预组和对照组。报告了 22 个月随访期间干预成本和医疗保健利用情况。使用 24 小时/7 天坐姿时间的客观测量以及基线、16 周、10 个月和 22 个月后的自我报告的健康评估问卷（HAQ）和 EQ-5D 评分作为结果。增量成本效益比作为成本效益进行报告，并以成本效益接受曲线表示统计不确定性。
干预成本估计为每位参与者 387 欧元。平均增量 22 个月医疗保健成本为-1165 欧元（95%自举置信区间为-5613 至 3283）。参与者中有 20%（置信区间为 10.4%至 29.6%）的人每天减少超过 50 分钟的久坐时间，36%的人报告 HAQ 评分改善（变化>0.22）。时间加权健康效用（质量调整生命年（QALY））分别增加了 0.10（置信区间为 0.02 至 0.18）和 0.11（置信区间为 0.04 至 0.19），用于 EQ-5D 指数和 EQ-VAS。干预措施通过提供更好的结果和更低的成本来主导常规生活方式。在 30000 欧元/QALY 的阈值下，干预措施有 95%的可能性具有成本效益。
本方案成本效益分析表明，针对减少类风湿关节炎患者久坐行为的个体化定制干预措施可改善参与者的 22 个月健康状况并降低医疗保健成本。这些结果表明，该干预措施应纳入常规风湿病护理中。
NCT01969604。
