TY - JOUR
T1 - Self-monitoring combined with patient-initiated care in RA patients with low disease activity
T2 - cost-effectiveness analysis of an RCT
AU - Seppen, Bart F.
AU - Greuter, Marjolein J. E.
AU - Wiegel, Jimmy
AU - ter Wee, Marieke M.
AU - Boers, Maarten
AU - Nurmohamed, Michael T.
AU - Bos, Wouter H.
N1 - Funding Information: This work was supported by AbbVie. AbbVie had no role in the design of this study, nor during its execution, analysis, interpretation of the data, or decision to submit results. Publisher Copyright: © 2023 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - OBJECTIVES: Self-monitoring and patient-initiated care (PIC) leads to fewer outpatient clinic visits in patients with established RA with low disease activity (LDA) while healthcare outcomes are similar. This study assesses the cost-effectiveness of PIC with self-monitoring. METHODS: A 12-month randomized controlled trial was performed with 49 patients in the PIC with self-monitoring group (app-group) and 53 in usual care. The usual care group continued with preplanned visits. The app group had one planned follow-up visit after 12 months and monitored their RA disease activity in a smartphone app. Both groups could make additional appointments at liberty. We included adult RA patients with a disease duration of over 2 years, a disease activity score 28 (DAS28) below 3.2 that were stable on medication for at least 6 months. The effect measure, the DAS28, was measured at 12 months and healthcare resource usage and productivity losses were measured at 3, 6, 9 and 12 months. RESULTS: There was no significant difference in mean change of DAS28 (-0.04 mean difference, 95% CI: -0.39, 0.30), nor a statistically significant difference in total costs (mean difference €514, 95% CI:-€266, €3690) in the app group compared with the usual care group. The probability that the app was cost-effective was 0.37 and 0.57 at a willingness-to-pay threshold of 0 and 50 000 €/point improvement DAS28, respectively. CONCLUSION: Although rheumatic care costs were significantly lower in the app group, total costs and effects of PIC with self-monitoring were not different from usual care in RA patients with LDA.
AB - OBJECTIVES: Self-monitoring and patient-initiated care (PIC) leads to fewer outpatient clinic visits in patients with established RA with low disease activity (LDA) while healthcare outcomes are similar. This study assesses the cost-effectiveness of PIC with self-monitoring. METHODS: A 12-month randomized controlled trial was performed with 49 patients in the PIC with self-monitoring group (app-group) and 53 in usual care. The usual care group continued with preplanned visits. The app group had one planned follow-up visit after 12 months and monitored their RA disease activity in a smartphone app. Both groups could make additional appointments at liberty. We included adult RA patients with a disease duration of over 2 years, a disease activity score 28 (DAS28) below 3.2 that were stable on medication for at least 6 months. The effect measure, the DAS28, was measured at 12 months and healthcare resource usage and productivity losses were measured at 3, 6, 9 and 12 months. RESULTS: There was no significant difference in mean change of DAS28 (-0.04 mean difference, 95% CI: -0.39, 0.30), nor a statistically significant difference in total costs (mean difference €514, 95% CI:-€266, €3690) in the app group compared with the usual care group. The probability that the app was cost-effective was 0.37 and 0.57 at a willingness-to-pay threshold of 0 and 50 000 €/point improvement DAS28, respectively. CONCLUSION: Although rheumatic care costs were significantly lower in the app group, total costs and effects of PIC with self-monitoring were not different from usual care in RA patients with LDA.
KW - RA
KW - cost-effectiveness
KW - eHealth
KW - smartphone
KW - telemonitoring
UR - http://www.scopus.com/inward/record.url?scp=85173560562&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/rheumatology/kead084
DO - https://doi.org/10.1093/rheumatology/kead084
M3 - Article
C2 - 36799560
SN - 1462-0324
VL - 62
SP - 3366
EP - 3372
JO - Rheumatology (Oxford, England)
JF - Rheumatology (Oxford, England)
IS - 10
ER -