Cost-effectiveness of a one-year coaching program for healthy physical activity in early rheumatoid arthritis

Abstract

Purpose: To describe cost-effectiveness of the Physical Activity in Rheumatoid Arthritis (PARA) study intervention. Method: Costs were collected and estimated retrospectively. Cost-effectiveness was calculated based on the intervention cost per patient with respect to change in health status (EuroQol global visual analog scale – EQ-VAS and EuroQol – EQ-5D) and activity limitation (Health assessment questionnaire – HAQ) using cost-effectiveness- and cost-minimization analyses. Results: Total cost of the one-year intervention program was estimated to be €67 317 or €716 per participant. Estimated difference in total societal cost between the intervention (IG) and control (CG) was €580 per participant. Incremental cost-effectiveness ratio (ICER) for one point (1/100) of improvement in EQ-VAS was estimated to be €116. By offering the intervention to more affected participants in the IG compared to less affected participants, 15.5 extra points of improvement in EQ-VAS and 0.13 points of improvement on HAQ were gained at the same cost. “Ordinary physiotherapy” was most cost-effective with regard to EQ-5D. Conclusions: The intervention resulted in improved effect in health status for the IG with a cost of €116 per extra point in VAS. The intervention was cost-effective if targeted towards a subgroup of more affected patients when evaluating the effect using VAS and HAQ.

Implications for Rehabilitation

• The physical activity coaching intervention resulted in an improved effect on VAS for the intervention group, to a higher cost.

• In order to maximize cost-effectiveness, this type of physical activity coaching intervention should be targeted towards patients largely affected by their RA.

• The intervention is cost-effective from the patients’ point of view, but not from that of the general population.

• Coaching intervention
• cost-effectiveness analysis
• economic evaluation
• health status
• rheumatoid arthritis

Declaration of interest

None of the authors declare any conflicts of interest. The project was supported by The Swedish Rheumatism Fund, The Swedish Research Council, and The Strategic Research Program in Health Care Research at Karolinska Institutet.