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Currently accepted at: Journal of Medical Internet Research

Date Submitted: Feb 1, 2018
Open Peer Review Period: Feb 1, 2018 - Mar 1, 2018
Date Accepted: May 8, 2018
(closed for review but you can still tweet)

This paper has been accepted and is currently in production.

It will appear shortly on 10.2196/jmir.9997

The final accepted version (not copyedited yet) is in this tab.

The final, peer-reviewed published version of this preprint can be found here:

Tailored, Therapist-Guided Internet-Based Cognitive Behavioral Therapy Compared to Care as Usual for Patients With Rheumatoid Arthritis: Economic Evaluation of a Randomized Controlled Trial

Ferwerda M, van Beugen S, van Middendorp H, Visser H, Vonkeman H, Creemers M, van Riel P, Kievit W, Evers A

Tailored, Therapist-Guided Internet-Based Cognitive Behavioral Therapy Compared to Care as Usual for Patients With Rheumatoid Arthritis: Economic Evaluation of a Randomized Controlled Trial

J Med Internet Res 2018;20(10):e260

DOI: 10.2196/jmir.9997

PMID: 30309835

PMCID: 6231867

Tailored, Therapist-Guided Internet-Based Cognitive Behavioral Therapy Compared to Care as Usual for Patients With Rheumatoid Arthritis: Economic Evaluation of a Randomized Controlled Trial

  • Maaike Ferwerda; 
  • Sylvia van Beugen; 
  • Henriët van Middendorp; 
  • Henk Visser; 
  • Harald Vonkeman; 
  • Marjonne Creemers; 
  • Piet van Riel; 
  • Wietske Kievit; 
  • Andrea Evers

ABSTRACT

Background:

Internet-based cognitive behavioral therapy can aid patients with rheumatoid arthritis with elevated levels of distress to enhance their quality of life. However, implementation is currently lacking and there is little evidence available on the (cost-) effectiveness of different treatment strategies.

Objective:

Cost-benefit ratios are necessary for informing stakeholders and motivating them to implement effective treatment strategies for improving health-related quality of life (HRQoL) of patients with rheumatoid arthritis. A cost-effectiveness study from a societal perspective was conducted alongside a randomized controlled trial on a tailored, therapist-guided internet-based cognitive behavioral therapy (ICBT) intervention for patients with rheumatoid arthritis with elevated levels of distress as an addition to care as usual (CAU).

Methods:

Data were collected at baseline or preintervention, 6 months or postintervention, and every 3 months thereafter during the 1-year follow-up. Effects were measured in terms of quality-adjusted life years (QALYs) and costs from a societal perspective, including health care sector costs (health care use, medication, and intervention costs), patient travel costs for health care use, and costs associated with loss of labor.

Results:

The intervention improved the quality of life compared with only CAU (Δ QALYs=0.059), but at a higher cost (Δ=€4211). However, this increased cost substantially reduced when medication costs were left out of the equation (Δ=€1863). Of all, 93% (930/1000) of the simulated incremental cost-effectiveness ratios were in the north-east quadrant, indicating a high probability that the intervention was effective in improving HRQoL, but at a greater monetary cost for society compared with only CAU.

Conclusions:

A tailored and guided ICBT intervention as an addition to CAU for patients with rheumatoid arthritis with elevated levels of distress was effective in improving quality of life. Consequently, implementation of ICBT into standard health care for patients with rheumatoid arthritis is recommended. However, further studies on cost reductions in this population are warranted. Trial Registration: Nederlands Trial Register NTR2100; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2100 (Archived by WebCite at http://www.webcitation.org/724t9pvr2)


 Citation

Please cite as:

Ferwerda M, van Beugen S, van Middendorp H, Visser H, Vonkeman H, Creemers M, van Riel P, Kievit W, Evers A

Tailored, Therapist-Guided Internet-Based Cognitive Behavioral Therapy Compared to Care as Usual for Patients With Rheumatoid Arthritis: Economic Evaluation of a Randomized Controlled Trial

Journal of Medical Internet Research. (forthcoming/in press)

DOI: 10.2196/jmir.9997

URL: https://preprints.jmir.org/preprint/9997

PMID: 30309835

PMCID: 6231867

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