Teuwen Mmh, van Weely Sfe, van den Ende Chm, van Wissen Mat, Vliet Vlieland Tpm, Peter W F, den Broeder A A, van Schaardenburg D, Gademan Mgj, van den Hout W B
Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands.
Institute of Allied Health Professions, HU University of Applied Sciences, Utrecht, The Netherlands.
Scand J Rheumatol. 2025 Mar;54(2):87-97. doi: 10.1080/03009742.2024.2392360. Epub 2024 Oct 1.
To evaluate the cost-effectiveness of longstanding personalized exercise therapy compared with usual care in people with rheumatoid arthritis (RA) and severe functional disability.
In this cost-utility analysis of a randomized controlled trial (n = 215), with 1 year follow-up, the study population comprised individuals with RA and reported severe difficulties in performing basic daily activities. Assessments were at baseline, 12, 26, and 52 weeks, with measurements of costs including medical and non-medical costs as recorded by patients and healthcare providers. Quality-adjusted life-years (QALYs) were estimated using the EuroQol 5 dimensions 5 levels (EQ-5D-5L) and EuroQol Visual Analogue Scale (EQ-VAS). Costs and QALY differences were analysed according to the intention-to-treat principle using cost-effectiveness acceptability curves.
The 1 year societal costs were non-significantly in favour of the usual care group, with a small difference of €180 [95% confidence interval (CI) €-4493 to €4852]. The QALYs were non-significantly in favour of the intervention group, by 0.02 according to the EQ-5D-5L (95% CI -0.05 to 0.09) and by 0.04 according to the EQ-VAS (95% CI 0.00 to 0.08). For a willingness-to-pay threshold of €50 000 per QALY, the intervention was the cost-effective strategy with 60% certainty.
This economic evaluation showed no clear economic preference for either group, as the intervention costs were higher in the intervention group, but partly compensated by other cost savings and improved QALYs. Despite severe RA, patients had better clinical outcomes compared with usual care, suggesting no economic reasons to refrain from exercise therapy.
Netherlands Trial Register NL8235, included in the International Clinical Trial Registry Platform (ICTRP) (https://trialsearch.who.int/Trial2.aspx?TrialID=NL8235).
评估长期个性化运动疗法与常规护理相比，对类风湿关节炎（RA）伴严重功能障碍患者的成本效益。
在这项随机对照试验（n = 215）的成本效用分析中，随访1年，研究人群包括患有RA且报告在进行基本日常活动时有严重困难的个体。评估在基线、12周、26周和52周进行，测量成本包括患者和医疗服务提供者记录的医疗和非医疗成本。使用欧洲五维度五水平量表（EQ-5D-5L）和欧洲视觉模拟量表（EQ-VAS）估计质量调整生命年（QALYs）。根据意向性分析原则，使用成本效益可接受性曲线分析成本和QALY差异。
1年的社会成本对常规护理组无显著优势，差异为180欧元[95%置信区间（CI）-4493欧元至4852欧元]。根据EQ-5D-5L，QALYs对干预组无显著优势，为0.02（95%CI -0.05至0.09）；根据EQ-VAS为0.04（95%CI 0.00至0.08）。对于每QALY支付意愿阈值为50000欧元，干预是具有60%确定性的成本效益策略。
这项经济评估显示两组之间没有明显的经济偏好，因为干预组的干预成本较高，但部分被其他成本节省和QALY改善所抵消。尽管患有严重的RA，但与常规护理相比，患者有更好的临床结果，这表明没有经济理由不采用运动疗法。
荷兰试验注册NL8235，纳入国际临床试验注册平台（ICTRP）（https://trialsearch.who.int/Trial2.aspx?TrialID=NL8235）。
