Session Title: Fibromyalgia and Soft Tissue Disorders II
Session Type: Abstract Submissions (ACR)
Although fibromyalgia is associated with substantial annual direct medical and indirect productivity costs, the cost-effectiveness of treatments for fibromyalgia remains understudied. A randomized controlled trial of tai chi mind-body exercises versus wellness education and stretching found tai chi to be safe and effective, so our aim was to assess the cost-effectiveness of tai chi for fibromyalgia in this trial.
The analysis is based on a single-blind, 12-week randomized trial of classic Yang-style tai chi compared with wellness education and stretching control for the treatment of fibromyalgia in 66 patients with 24 week follow up (NEJM 2010; 363:743-54). Effectiveness outcomes from baseline to week 24 included Fibromyalgia Impact Questionnaire (FIQ) score, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) quality of life (QOL), pain score using the visual analog scale (VAS) and Health Assessment Questionnaire Disability Index (HAQ). Hourly costs were based on an Internet search with Tai Chi costing $17.50 ($10-$25) and stretching costing $12 ($9-$15). A systematic review of Medline from inception to 2011 for economic studies regarding fibromyalgia found annual direct medical care costs of $3700 equaling 1.7 to 2.9 times population controls and indirect costs that were 1.7 to 2.2 times direct medical care costs (ACR #902 Arthritis Rheum 2011;63 Suppl 10:S354-5). Statistical testing for differences used the two sample t-test and mixed models with time and group as categorical fixed factors. A linear regression related HAQ to mean direct care costs (R-square 0.96).
The mean difference improvement with tai chi versus wellness education and stretching control in FIQ was 18.3 (95% CI 9.6-27.1, p<0.001); in SF36 QOL physical health was 7.0 (2.9-11.0, p=0.001) and SF36 QOL mental health was 7.3 (1.9-2.8, p=0.009); in VAS pain was 2.1 (95% CI 0.74-3.5, p=0.003); and in HAQ was 0.21 (95% CI 0.037-0.390, p=0.019). Assuming no reduction in health care utilization from tai chi, the incremental cost-effectiveness of tai chi versus wellness education and stretching was $4 (95% CI $2-$7) per 1 point improvement in FIQ; $9 (95% CI $5-35) per 1 point improvement in physical or mental QOL; $31 (95% CI $19-$89) per 1 point improvement in VAS pain score and $314 (95% CI $169-$1784) per 1 point improvement in HAQ. Assuming that the improved HAQ disability index decreases health care utilization, tai chi results in an estimated savings of $366 (95% CI $9-$724) per patient over 6 months. Assuming that the observed decreased HAQ disability index decreases health care utilization and productivity losses, tai chi results in an estimated savings of $775 (95% CI $80-$1474) per patient over 6 months.
Compared with wellness intervention and stretching, tai chi improves FIQ score, SF36 QOL, VAS pain score and HAQ significantly. Costs per unit improvement appear to be quite modest, and assuming that improvement in HAQ would lead to direct and indirect cost reductions, tai chi would be cost-saving. Confirmation of these results in a larger randomized controlled trial is needed.
J. B. Wong,
1UL1RR025752-01 from the Clinical and Translational Research Center funded by the National Institutes of Health National Center for Research Resources,
1R21AT003621 from the National Center for Complementary and Alternative Medicine, the American College of Rheumatology Research and Education Health Professional Investigator Award and 1UL1RR025752-01 from the Clinical and Translational Research Center,
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