OP0130-HPR COST-UTILITY ANALYSIS OF LONGSTANDING EXERCISE THERAPY VERSUS USUAL CARE IN PEOPLE WITH RHEUMATOID ARTHRITIS AND SEVERE FUNCTIONAL LIMITATIONS

Background:

Whereas there is limited evidence for the effectiveness of exercise therapy in people with Rheumatoid Arthritis (RA) [1], economic analyses on its cost-effectiveness are scarce. Recently, a randomized controlled trial (RCT) showed that a personalized, longstanding (>52 weeks) exercise therapy was more effective than usual care with respect to functional ability and quality of life in people with RA and severe functional disability [2].

Objectives:

To evaluate the cost-effectiveness of personalized, longstanding exercise therapy versus usual care for individuals with RA and severe functional disability.

Methods:

A cost-utility analysis from a societal perspective was conducted as part of the RCT involving 215 people with RA experiencing severe functional disability, and spanning a one-year follow-up period with assessments at baseline, 12, 26, and 52 weeks. Assessments of costs included medical and non-medical costs as recorded by patients and health care providers. Measurements of utility included the EuroQol-5D (EQ-5D-5L), and the EuroQol Visual Analog Scale (EQ-VAS). Quality-adjusted life years (QALYs) were calculated by the area under the curve of each of these utility measures over the follow-up period anchored at 0 (as bad as death) and 1 (perfect health). Costs and QALY differences were analyzed according to the intention-to-treat principle using cost-effectiveness acceptability curves.

Results:

A total of 215 individuals with RA, predominantly female (90%), with a mean age of 59 years (SD=13) with severe functional disability, were randomized to the intervention group (n=109) or the usual care group (n=106). The mean direct intervention costs were €1423 per patient in the intervention group, with a mean 39 sessions in the 99 (91%) patients who used it (Table 1). The 1-year societal cost were non-significantly in favor of the usual care group with a small difference of €180 (95% confidence interval (CI) €-4493 to €4852). The QALYs were non-significantly in favor 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 (Figure 1).

Conclusion:

This economic evaluation showed no clear economic preference, as the intervention costs were offset by other cost savings and improved QALYs. Given the better clinical outcomes of the longstanding exercise therapy intervention, there are no economic reasons to withhold it from patients with RA and severe functional limitations. Registration number: Netherlands Trial Register NL8235, included in the International Clinical Trial Registry Platform (ICTRP) (https://trialsearch.who.int/Trial2.aspx?TrialID=NL8235).Funding: This project is financially supported by the Netherlands Organization for Health Research and Development (ZonMw; 852004018), Ministry of Health, Welfare and Sport (Ministerie van Volksgezondheid, Welzijn en Sport), the Royal Dutch Society for Physical Therapy (KNGF) and the Dutch Arthritis Society (ReumaNederland).

REFERENCES:

[1] Ye et al. BMC Sports Sci Med Rehabil 2022;14(1):17. [2] Teuwen et al. Ann Rheum Dis 2024 doi: 10.1136/ard-2023-224912.

Acknowledgements:

All authors declare that they do not have conflicts of interest.

Disclosure of Interests:

None declared.