Cost-utility and cost-effectiveness analyses of a long-term, high-intensity exercise program compared with conventional physical therapy in patients with rheumatoid arthritis

被引:56
作者
van den Hout, WB [1 ]
de Jong, Z [1 ]
Munneke, M [1 ]
Hazes, JMW [1 ]
Breedveld, FC [1 ]
Vlieland, TPMV [1 ]
机构
[1] Leiden Univ, Ctr Med, Dept Med Decis Making J10 S, NL-2300 RC Leiden, Netherlands
来源
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH | 2005年 / 53卷 / 01期
关键词
cost-utility analysis; cost-effectiveness analysis; economic evaluation; physical therapy; exercise classes; rheumatoid arthritis;
D O I
10.1002/art.20903
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective. To estimate the cost utility and cost effectiveness of long-term, high-intensity exercise classes compared with usual care in rheumatoid arthritis (RA) patients. Methods. RA patients (n = 300) were randomly assigned to either exercise classes or UC; followup lasted for 2 years. Outcome measures were quality-adjusted life years (QALYs) according to the EuroQol (EQ-5D), Short Form 6D (SF-6D), and a transformed visual analog scale (VAS) rating personal health; functional ability according to the Health Assessment Questionnaire (HAQ) and McMaster Toronto Arthritis Patient Preference Interview (MACTAR); and societal costs. Results. QALYs in both randomization groups were similar according to the EQ-5D and SF-6D, but were in favor of usual care according to the VAS (annual difference 0.037 QALY; 95% confidence interval [95% CI] 0.002, 0.069). Functional ability was similar according to the HAQ, but in favor of the exercise classes according to the MACTAR (annual difference 2.9 QALY; 95% CI 0.9, 4.9). Annual medical costs of the exercise program were estimated at euro780 per participating patient (euro1 approximate to $1.05). The increase per patient in total medical costs of physical therapy was estimated at euro 430 (95% CI euro 318, 577), and the a increase in total societal costs at euro 602 (95% CI euro-490, 1,664). For societal willingness-to-pay equal to euro 50,000 per QALY. usual care had better cost utility than exercise classes, and significantly so according to the VAS. Conclusion. From a societal perspective and without taking possible preventive health effects into account, long-term, high-intensity exercise classes provide insufficient improvement in the valuation of health to justify the additional costs.
引用
收藏
页码:39 / 47
页数:9
相关论文
共 46 条
[31]   Value of the time trade off method for measuring utilities in patients with rheumatoid arthritis [J].
Tijhuis, GJ ;
Jansen, SJT ;
Stiggelbout, AM ;
Zwinderman, AH ;
Hazes, JMW ;
Vlieland, TPMV .
ANNALS OF THE RHEUMATIC DISEASES, 2000, 59 (11) :892-897
[32]   MEASUREMENT OF HEALTH STATE UTILITIES FOR ECONOMIC APPRAISAL - A REVIEW [J].
TORRANCE, GW .
JOURNAL OF HEALTH ECONOMICS, 1986, 5 (01) :1-30
[33]  
TUGWELL P, 1987, J RHEUMATOL, V14, P446
[34]   What is the price of life and why doesn't it increase at the rate of inflation? [J].
Ubel, PA ;
Hirth, RA ;
Chernew, ME ;
Fendrick, AM .
ARCHIVES OF INTERNAL MEDICINE, 2003, 163 (14) :1637-1641
[35]   Cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis: a randomised comparison of clinical nurse specialist care, inpatient team care, and day patient team care [J].
van den Hout, WB ;
Tijhuis, GJ ;
Hazes, JMW ;
Breedveld, FC ;
Vlieland, TPMV .
ANNALS OF THE RHEUMATIC DISEASES, 2003, 62 (04) :308-315
[36]   Comparison of high and low intensity training in well controlled rheumatoid arthritis. Results of a randomised clinical trial [J].
vandenEnde, CHM ;
Hazes, JMW ;
leCessie, S ;
Mulder, WJ ;
Belfor, DG ;
Breedveld, FC ;
Dijkmans, BAC .
ANNALS OF THE RHEUMATIC DISEASES, 1996, 55 (11) :798-805
[37]  
vandenEnde CHM, 1997, J RHEUMATOL, V24, P1972
[38]  
Verhoeven AC, 2000, J RHEUMATOL, V27, P2801
[39]  
Westby MD, 2000, J RHEUMATOL, V27, P1674
[40]  
Westby MD, 2001, ARTHRIT RHEUM-ARTHR, V45, P501