A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis. (30th July 2020)

• Record Type: Journal Article
• Authors: McBain, Hayley; Flood, Chris; Shipley, Michael; Olaleye, Abigail; Moore, Samantha; Newman, Stanton
• Is Part Of: Rheumatology. Volume 60:Number 1(2021)
• Page Start: 277
• Page End: 287
• Publication Date: 2020-07-30
• Subjects: rheumatoid arthritis -- psoriatic arthritis -- economic evaluation -- health-services research; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keaa309
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objective: To determine whether a patient-initiated DMARD self-monitoring service for people on MTX is a cost-effective model of care for patients with RA or PsA. Methods: An economic evaluation was undertaken alongside a randomized controlled trial involving 100 patients. Outcome measures were quality of life and ESR assessed at baseline and post-intervention. Costs were calculated for healthcare usage using a United Kingdom National Health Service economic perspective. Sensitivity analysis was performed to explore the impact of nurse-led telephone helplines. Uncertainty around the cost-effectiveness ratios was estimated by bootstrapping and analysing the cost-effectiveness planes. Results: Fifty-two patients received the intervention and 48 usual care. The difference in mean cost per case indicated that the intervention was £263 more expensive ( P < 0.001; 95% CI: £149.14, £375.86) when the helpline costs were accounted for and £94 cheaper ( P = 0.08; 95% CI: –£199.26, £10.41) when these costs were absorbed by the usual service. There were, however, statistically significant savings for the patient ( P = 0.02; 95% CI: −£28.98, £3.00). When costs and effectiveness measures of ESR and quality of life measured, using the Short Form-12v1, were combined this did not show the patient-initiated service to be cost-effective at a statistically significant level. Conclusion: This patient-initiated service led to reductions in primary and secondary healthcare services that translated into reduced costs, in comparison with usual care, but were not cost-effective. Further work is needed to establish how nurse-led telephone triage services are integrated into rheumatology services and the associated costs of setting up and delivering them. Trial registration: ClinicalTrials.gov, http://clinicaltrials.gov, ISRCTN21613721