Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
Rheumatology (Oxford). 2023 Dec 1;62(12):3819-3827. doi: 10.1093/rheumatology/kead157.
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.
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.
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.
The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.
评估认知行为疗法（CBA）或个性化运动方案（PEP）与常规护理（UC）联合用于报告慢性、中重度疲劳的炎症性风湿病患者的成本效益。
采用多中心三臂随机对照试验（试验期 56 周）中的个体患者数据进行试验内成本效用分析。主要经济学分析从英国国家医疗服务体系（NHS）角度进行。采用成本效用接受曲线和敏感性分析来探讨不确定性。
完全案例分析显示，与 UC 相比，PEP 和 CBA 均更昂贵[校正平均成本差异：PEP£569（95%可信区间：£464，£665）；CBA£845（95%可信区间：£717，£993）]，且 PEP 的效果显著更好[校正平均质量调整生命年（QALY）差异：PEP0.043（95%可信区间：0.019，0.068）；CBA0.001（95%可信区间：-0.022，0.022）]。这导致 PEP 对比 UC 的增量成本效益比（ICER）为£13159，CBA 对比 UC 的为£793777。非参数自举法显示，在 20000 英镑/QALY 的阈值下，PEP 有 88%的可能性是具有成本效益的。在多重插补分析中，PEP 与 428 英镑的增量成本相关（95%可信区间：£324，£511），且 QALY 无显著获益 0.016（95%可信区间：-0.003，0.035），导致其对比 UC 的 ICER 为£26822。敏感性分析的结果与这些结果一致。
在 UC 的基础上增加 PEP 可能会更有效地利用医疗保健资源。
