A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis
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 we...
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| Veröffentlicht in: | Rheumatology (Oxford, England) England), 2021-01, Vol.60 (1), p.277-287 |
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| creator | McBain, Hayley Flood, Chris Shipley, Michael Olaleye, Abigail Moore, Samantha Newman, Stanton |
| description | 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 |
| doi_str_mv | 10.1093/rheumatology/keaa309 |
| format | Article |
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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</description><identifier>ISSN: 1462-0324</identifier><identifier>EISSN: 1462-0332</identifier><identifier>DOI: 10.1093/rheumatology/keaa309</identifier><identifier>PMID: 32734288</identifier><language>eng</language><publisher>OXFORD: Oxford University Press</publisher><subject>Antirheumatic Agents - therapeutic use ; Arthritis, Psoriatic - drug therapy ; Arthritis, Rheumatoid - drug therapy ; Cost-Benefit Analysis ; Drug Monitoring - economics ; Health Care Costs ; Humans ; Life Sciences & Biomedicine ; Methotrexate - therapeutic use ; National Health Programs - economics ; Outcome Assessment, Health Care ; Practice Patterns, Nurses ; Quality of Life ; Rheumatology ; Science & Technology ; Uncertainty ; United Kingdom</subject><ispartof>Rheumatology (Oxford, England), 2021-01, Vol.60 (1), p.277-287</ispartof><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>1</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000610050100053</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c393t-608f9b3fb5c6901a8a380195562d4b79d0e887681444c132350fddbd09251c963</citedby><cites>FETCH-LOGICAL-c393t-608f9b3fb5c6901a8a380195562d4b79d0e887681444c132350fddbd09251c963</cites><orcidid>0000-0002-6742-1104 ; 0000-0001-6712-6079</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27933,27934,39266,39267</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32734288$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McBain, Hayley</creatorcontrib><creatorcontrib>Flood, Chris</creatorcontrib><creatorcontrib>Shipley, Michael</creatorcontrib><creatorcontrib>Olaleye, Abigail</creatorcontrib><creatorcontrib>Moore, Samantha</creatorcontrib><creatorcontrib>Newman, Stanton</creatorcontrib><title>A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis</title><title>Rheumatology (Oxford, England)</title><addtitle>RHEUMATOLOGY</addtitle><addtitle>Rheumatology (Oxford)</addtitle><description>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</description><subject>Antirheumatic Agents - therapeutic use</subject><subject>Arthritis, Psoriatic - drug therapy</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Cost-Benefit Analysis</subject><subject>Drug Monitoring - economics</subject><subject>Health Care Costs</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Methotrexate - therapeutic use</subject><subject>National Health Programs - economics</subject><subject>Outcome Assessment, Health Care</subject><subject>Practice Patterns, Nurses</subject><subject>Quality of Life</subject><subject>Rheumatology</subject><subject>Science & Technology</subject><subject>Uncertainty</subject><subject>United Kingdom</subject><issn>1462-0324</issn><issn>1462-0332</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>GIZIO</sourceid><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><recordid>eNqNkF1PwyAUhonROL_-gTHcmzoobQfeLZtficbE6HVD6WFDu9IA27Jbf7ksdYuXXgGH531z8iB0SckNJYIN3RyWCxlsY2eb4RdIyYg4QCc0K9KEMJYe7u9pNkCn3n8SQnLK-DEasHTEspTzE_Q9xp0MBtqQmNYEIwPUePoyfptiD41OFjZOrTPtLL7dyijA2jrcge0awGsT5ni3iKnx9sdHOjYqLF2Yu1jpb7HEyvqQgNaggllBC95j2cpm440_R0daNh4ufs8z9HF_9z55TJ5fH54m4-dEMcFCUhCuRcV0latCECq5ZJxQkedFWmfVSNQEOB8VnGZZpihLWU50XVc1EWlOlSjYGcr6XuWs9w502TmzkG5TUlJulZZ_lZa_SmPsqo91y2oB9T60cxgB3gNrqKz2KspUsMei9IJG8YRu9bOJCVGObSd22YYYvf5_NNLDnrbL7n-7_wC8q6sW</recordid><startdate>20210105</startdate><enddate>20210105</enddate><creator>McBain, Hayley</creator><creator>Flood, Chris</creator><creator>Shipley, Michael</creator><creator>Olaleye, Abigail</creator><creator>Moore, Samantha</creator><creator>Newman, Stanton</creator><general>Oxford University Press</general><general>Oxford Univ Press</general><scope>17B</scope><scope>BLEPL</scope><scope>DTL</scope><scope>DVR</scope><scope>EGQ</scope><scope>GIZIO</scope><scope>HGBXW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><orcidid>https://orcid.org/0000-0002-6742-1104</orcidid><orcidid>https://orcid.org/0000-0001-6712-6079</orcidid></search><sort><creationdate>20210105</creationdate><title>A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis</title><author>McBain, Hayley ; Flood, Chris ; Shipley, Michael ; Olaleye, Abigail ; Moore, Samantha ; Newman, Stanton</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-608f9b3fb5c6901a8a380195562d4b79d0e887681444c132350fddbd09251c963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Antirheumatic Agents - therapeutic use</topic><topic>Arthritis, Psoriatic - drug therapy</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Cost-Benefit Analysis</topic><topic>Drug Monitoring - economics</topic><topic>Health Care Costs</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Methotrexate - therapeutic use</topic><topic>National Health Programs - economics</topic><topic>Outcome Assessment, Health Care</topic><topic>Practice Patterns, Nurses</topic><topic>Quality of Life</topic><topic>Rheumatology</topic><topic>Science & Technology</topic><topic>Uncertainty</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McBain, Hayley</creatorcontrib><creatorcontrib>Flood, Chris</creatorcontrib><creatorcontrib>Shipley, Michael</creatorcontrib><creatorcontrib>Olaleye, Abigail</creatorcontrib><creatorcontrib>Moore, Samantha</creatorcontrib><creatorcontrib>Newman, Stanton</creatorcontrib><collection>Web of Knowledge</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Social Sciences Citation Index</collection><collection>Web of Science Primary (SCIE, SSCI & AHCI)</collection><collection>Web of Science - Social Sciences Citation Index – 2021</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Rheumatology (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McBain, Hayley</au><au>Flood, Chris</au><au>Shipley, Michael</au><au>Olaleye, Abigail</au><au>Moore, Samantha</au><au>Newman, Stanton</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis</atitle><jtitle>Rheumatology (Oxford, England)</jtitle><stitle>RHEUMATOLOGY</stitle><addtitle>Rheumatology (Oxford)</addtitle><date>2021-01-05</date><risdate>2021</risdate><volume>60</volume><issue>1</issue><spage>277</spage><epage>287</epage><pages>277-287</pages><issn>1462-0324</issn><eissn>1462-0332</eissn><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</abstract><cop>OXFORD</cop><pub>Oxford University Press</pub><pmid>32734288</pmid><doi>10.1093/rheumatology/keaa309</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-6742-1104</orcidid><orcidid>https://orcid.org/0000-0001-6712-6079</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Web of Science - Social Sciences Citation Index – 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Alma/SFX Local Collection |
| subjects | Antirheumatic Agents - therapeutic use Arthritis, Psoriatic - drug therapy Arthritis, Rheumatoid - drug therapy Cost-Benefit Analysis Drug Monitoring - economics Health Care Costs Humans Life Sciences & Biomedicine Methotrexate - therapeutic use National Health Programs - economics Outcome Assessment, Health Care Practice Patterns, Nurses Quality of Life Rheumatology Science & Technology Uncertainty United Kingdom |
| title | A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis |
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