Background/Purpose: Economic evaluations of interventions, as a complement to the effect evaluation, intend to inform decision makers about whether an intervention provides good value for the money. Since resources in healthcare are scarce, there is an increased demand from decision makers for economic evaluations. Economic evaluations of non-pharmacologic care in RA are still not as commonly presented as evaluations of the costs related to medications, for example. At the CARE VI meeting, the importance of such evaluations was acknowledged. Thus, the aim of the present study was to describe cost-effectiveness and cost-utility of a one-year coaching program aimed at increasing daily physical activity in RA,  previously studied in the Physical Activity in Rheumatoid Arthritis (PARA) study.

Methods: The protocol for the PARA study is available at http://www.controlled-trials.com/ISRCTN88886304/. Costs were collected and estimated retrospectively. The study was performed from 2000 to 2004 and all costs were deflated using gross domestic product with 2005 as a reference year. Cost-effectiveness was calculated based on the intervention cost per patient, with respect to health status (EuroQol visual analog scale, EQ-VAS) and activity limitation (Health assessment questionnaire, HAQ). To calculate cost utility, Quality adjusted life years (QALY) was used based on the EuroQol-5D.

Results: The cost of the one-year intervention program was estimated to €44 224 of which 65% were for treatment and 35% for education, project activities and administration. Estimated difference in total societal cost between the intervention (IG) and control (CG) was €372 per patient. ICER for one point (1/100) of improvement in EQ-VAS was estimated to €72. By offering the intervention exclusively to more affected patients (MO), both the effectiveness and cost-effectiveness were improved. The estimated ICER for a one-point improvement in EQ-VAS was €35 for MO in the IG compared to MO in the CG. By offering the intervention to MO in the IG only, and not to less affected patients (LE), an extra point of improvement in EQ-VAS would cost €21. An extra gain in QALY for this group would cost €3585 and for one extra point (1.0) of improvement in HAQ, the cost would be €1517.

Conclusion: The intervention resulted in improved effect on EQ-VAS for the intervention group with a cost of €72 per extra point. The result reveals that the cost per QALY and ICER for improvement in health status was lower in the subgroup with more affected patients (MO) in the IG compared to in the CG with the same level of disability. The cost per QALY and ICER for improvement in health status was even lower when comparing more affected patients (MO) to less affected patients (LE) within the IG. This indicates that from a societal perspective, it would be more cost-effective to offer this kind of intervention exclusively to more affected patients with RA, than to all patients with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cost-effectiveness-and-cost-utility-of-a-one-year-coaching-program-for-healthy-physical-activity-in-rheumatoid-arthritis/