Cost-effectiveness of cognitive behavioural and personalized exercise interventions for reducing fatigue in inflammatory rheumatic diseases

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 pound (95% CI: 464 pound, 665); pound CBA 845 pound (95% CI: 717 pound, 993)] pound 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 pound 159 for PEP vs UC, and 793 pound 777 for CBA vs UC. Non-parametric bootstrapping showed that, at a threshold value of 20 pound 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 pound (95% CI: 324 pound, 511) pound and a non-significant QALY gain of 0.016 (95% CI: -0.003, 0.035), leading to an ICER of 26 pound 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.