TY - JOUR
T1 - Cost-effectiveness of a telehealth intervention in rheumatoid arthritis
T2 - economic evaluation of the Telehealth in RA (TeRA) randomized controlled trial
AU - Skovsgaard, Christian
AU - Kruuse, Marie
AU - Hjollund, N. H.I.
AU - Maribo, T.
AU - de Thurah, A.
N1 - Publisher Copyright:
© 2022 Scandinavian Journal of Rheumatology Foundation.
PY - 2023
Y1 - 2023
N2 - Objective: Telehealth is rapidly gaining ground from usual treatment, not least because of coronavirus disease 2019 (COVID-19) measures. Within rheumatology, telehealth has been used for, inter alia, follow-up for patients with rheumatoid arthritis (RA) with low disease activity or in remission. This study aims to assess the cost-effectiveness of such a telehealth intervention. Method: In a randomized controlled trial, 294 patients were randomized into patient-reported outcome-based telehealth follow-up by either a nurse (PRO-TN) or a rheumatologist (PRO-TR) or to conventional outpatient follow-up (control). Cost-effectiveness was evaluated using costs per quality-adjusted life-year (QALY) gained. Individual-level healthcare and productivity costs were retrieved from national Danish registers. Incremental cost-effectiveness ratios were calculated for the intervention groups compared to the control group. Bootstrapping with 10 000 replications was used to obtain confidence intervals. Furthermore, cost-effectiveness acceptability curves were generated. Results: The cost comparison showed that PRO-TR was significantly less costly than the control group, whereas the relative reduction in costs for PRO-TN was not significant. The telehealth groups experienced minor, non-significant declines in QALYs, whereas the control group experienced a slight, non-significant increase. The cost-effectiveness analysis showed that for PRO-TR, the willingness to accept a QALY loss was 89 328 EUR. A similar but smaller and non-significant result was seen for PRO-TN. Conclusion: PRO-TR and PRO-TN seem to cost less but provide broadly similar health outcomes compared with conventional follow-up. Between the intervention groups, PRO-TR was significantly less costly. More studies are needed to conclude whether rheumatologist- or nurse-led telehealth is more cost-effective than conventional follow-up.
AB - Objective: Telehealth is rapidly gaining ground from usual treatment, not least because of coronavirus disease 2019 (COVID-19) measures. Within rheumatology, telehealth has been used for, inter alia, follow-up for patients with rheumatoid arthritis (RA) with low disease activity or in remission. This study aims to assess the cost-effectiveness of such a telehealth intervention. Method: In a randomized controlled trial, 294 patients were randomized into patient-reported outcome-based telehealth follow-up by either a nurse (PRO-TN) or a rheumatologist (PRO-TR) or to conventional outpatient follow-up (control). Cost-effectiveness was evaluated using costs per quality-adjusted life-year (QALY) gained. Individual-level healthcare and productivity costs were retrieved from national Danish registers. Incremental cost-effectiveness ratios were calculated for the intervention groups compared to the control group. Bootstrapping with 10 000 replications was used to obtain confidence intervals. Furthermore, cost-effectiveness acceptability curves were generated. Results: The cost comparison showed that PRO-TR was significantly less costly than the control group, whereas the relative reduction in costs for PRO-TN was not significant. The telehealth groups experienced minor, non-significant declines in QALYs, whereas the control group experienced a slight, non-significant increase. The cost-effectiveness analysis showed that for PRO-TR, the willingness to accept a QALY loss was 89 328 EUR. A similar but smaller and non-significant result was seen for PRO-TN. Conclusion: PRO-TR and PRO-TN seem to cost less but provide broadly similar health outcomes compared with conventional follow-up. Between the intervention groups, PRO-TR was significantly less costly. More studies are needed to conclude whether rheumatologist- or nurse-led telehealth is more cost-effective than conventional follow-up.
KW - Arthritis, Rheumatoid/therapy
KW - COVID-19/epidemiology
KW - Cost-Benefit Analysis
KW - Cost-Effectiveness Analysis
KW - Humans
KW - Quality-Adjusted Life Years
KW - Telemedicine
UR - http://www.scopus.com/inward/record.url?scp=85123430730&partnerID=8YFLogxK
U2 - 10.1080/03009742.2021.2008604
DO - 10.1080/03009742.2021.2008604
M3 - Journal article
C2 - 35048793
AN - SCOPUS:85123430730
SN - 0300-9742
VL - 52
SP - 118
EP - 128
JO - Scandinavian Journal of Rheumatology
JF - Scandinavian Journal of Rheumatology
IS - 2
ER -