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Cost-utility of a multicomponent intervention for fibromyalgia versus usual care: a pragmatic randomised controlled
Victoria Mailen Arfuch1, Carina Aguilar Martín2, Anna Berenguera3
1Terres de l'Ebre Research Support Unit, Jordi Gol I Gurina Primary Health Research Institute Foundation (IDIAPJGol), Tortosa, Spain; Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Autonomous University of Barcelona, Bellaterra, Spain; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. victoria.arfuch.prezioso@ki.se.
Objective:
To perform an economic evaluation on a multicomponent intervention programme for patients with fibromyalgia syndrome compared with usual clinical practice in primary care.
Design:
A cost-utility analysis was conducted alongside a pragmatic randomised controlled trial (ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/record/NCT04049006) from a societal perspective, a human capital approach, and a 1-year time horizon.
Patients:
Patients diagnosed with fibromyalgia syndrome from the public health system in south Catalonia, Spain.
Methods:
Crude and adjusted incremental cost- utility ratios were estimated to compare the treatment strategies based on cost estimations (direct medical costs and productivity losses) and quality-adjusted life years. One-way and 2-way deterministic sensitivity analyses were performed.
Results:
The final analysed sample comprised 297 individuals, 161 in the intervention group and 136 in the control group. A crude incremental cost-utility ratio of € 1,780.75 and an adjusted ratio of € 851.67 were obtained, indicating that the programme significantly improved patients' quality of life with a cost-increasing outcome that fell below the cost-effectiveness threshold. The sensitivity analysis confirmed these findings when varying large cost components, and showed dominance when increasing session attendance.
Conclusion:
The proposed multicomponent intervention programme was cost-effective compared with usual care for fibromyalgia, which supports its addition to standard practice in the regional primary care service.
