A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis.

Journal article


McBain, H., Flood, C., Shipley, M., Olaleye, A., Moore, S. and Newman, S. (2020). A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis. Rheumatology. 30 (1), pp. 277-287. https://doi.org/10.1093/rheumatology/keaa309
AuthorsMcBain, H., Flood, C., Shipley, M., Olaleye, A., Moore, S. and Newman, S.
AbstractTo 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. 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. 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. 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. ClinicalTrials.gov, http://clinicaltrials.gov, ISRCTN21613721. [Abstract copyright: © 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.]
Keywordseconomic evaluation; health-services research; psoriatic arthritis; rheumatoid arthritis
Year2020
JournalRheumatology
Journal citation30 (1), pp. 277-287
PublisherOxford University Press (OUP)
ISSN1462-0332
Digital Object Identifier (DOI)https://doi.org/10.1093/rheumatology/keaa309
Publication dates
Online30 Jul 2020
Publication process dates
Accepted08 Mar 2020
Deposited03 Mar 2021
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This is a pre-copyedited, author-produced version of an article accepted for publication in Rheumatology following peer review. The version of record Hayley McBain, Chris Flood, Michael Shipley, Abigail Olaleye, Samantha Moore, Stanton Newman, A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis, Rheumatology, Volume 60, Issue 1, January 2021, Pages 277–287 is available online at: https://academic.oup.com/rheumatology/article-abstract/60/1/277/5879...

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