Cost-utility analysis of longstanding exercise therapy versus usual care in people with rheumatoid arthritis and severe functional limitations.

IF 2.2 4区医学 Q3 RHEUMATOLOGY

Scandinavian Journal of Rheumatology Pub Date : 2024-10-01 DOI:10.1080/03009742.2024.2392360

Mmh Teuwen, Sfe van Weely, Chm van den Ende, Mat van Wissen, Tpm Vliet Vlieland, W F Peter, A A den Broeder, D van Schaardenburg, Mgj Gademan, W B van den Hout

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引用次数: 0

Abstract

Objective: To evaluate the cost-effectiveness of longstanding personalized exercise therapy compared with usual care in people with rheumatoid arthritis (RA) and severe functional disability.

Method: 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.

Results: 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.

Conclusion: 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.

Trial registration number: Netherlands Trial Register NL8235, included in the International Clinical Trial Registry Platform (ICTRP) (https://trialsearch.who.int/Trial2.aspx?TrialID=NL8235).

查看原文本刊更多论文

对患有类风湿性关节炎且功能严重受限的患者进行长期运动疗法与常规护理的成本效益分析。

目的评估对类风湿性关节炎（RA）和严重功能障碍患者进行长期个性化运动疗法与常规护理相比的成本效益：在这项随机对照试验（n = 215）的成本效益分析中，研究对象包括类风湿性关节炎患者，他们在进行基本日常活动时有严重困难。评估时间为基线、12周、26周和52周，成本测量包括患者和医疗服务提供者记录的医疗和非医疗成本。质量调整生命年（QALYs）采用欧洲质量标准五维五级（EQ-5D-5L）和欧洲质量标准视觉模拟量表（EQ-VAS）进行估算。根据意向治疗原则，利用成本效益可接受性曲线对成本和 QALY 差异进行了分析：结果：1 年的社会成本显著低于常规护理组，差异为 180 欧元[95% 置信区间（CI）为 4493 欧元至 4852 欧元]。干预组的 QALYs 无显著性差异，根据 EQ-5D-5L 测量，干预组的 QALYs 为 0.02（95% 置信区间 -0.05 至 0.09），根据 EQ-VAS 测量，干预组的 QALYs 为 0.04（95% 置信区间 0.00 至 0.08）。在每 QALY 50 000 欧元的支付意愿阈值下，干预是具有成本效益的策略，确定性为 60%：这项经济评估结果显示，两组患者都没有明显的经济偏好，因为干预组的干预成本较高，但其他费用的节省和 QALY 的提高部分弥补了这一偏好。尽管RA病情严重，但与常规治疗相比，患者的临床疗效更好，这表明没有经济理由不采用运动疗法：试验登记号：荷兰试验登记NL8235，已纳入国际临床试验登记平台（ICTRP）（https://trialsearch.who.int/Trial2.aspx?TrialID=NL8235）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Scandinavian Journal of Rheumatology 医学-风湿病学

CiteScore

3.70

自引率

4.80%

发文量

审稿时长

6-12 weeks

期刊介绍： Scandinavian Journal of Rheumatology is the official journal of the Scandinavian Society for Rheumatology, a non-profit organization following the statutes of the Scandinavian Society for Rheumatology/Scandinavian Research Foundation. The main objective of the Foundation is to support research and promote information and knowledge about rheumatology and related fields. The annual surplus by running the Journal is awarded to young, talented, researchers within the field of rheumatology.pasting The Scandinavian Journal of Rheumatology is an international scientific journal covering clinical and experimental aspects of rheumatic diseases. The journal provides essential reading for rheumatologists as well as general practitioners, orthopaedic surgeons, radiologists, pharmacologists, pathologists and other health professionals with an interest in patients with rheumatic diseases. The journal publishes original articles as well as reviews, editorials, letters and supplements within the various fields of clinical and experimental rheumatology, including; Epidemiology Aetiology and pathogenesis Treatment and prophylaxis Laboratory aspects including genetics, biochemistry, immunology, immunopathology, microbiology, histopathology, pathophysiology and pharmacology Radiological aspects including X-ray, ultrasonography, CT, MRI and other forms of imaging.