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Economic evaluation alongside the multicenter randomized controlled ACTIVE trial: cost-effectiveness of an integrated
A Carlien Straat1, P Paul F M Kuijer1, Daniël O Strijbos2
1Amsterdam UMC, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, the Netherlands; Amsterdam Movement Sciences Research Institute, Musculoskeletal Health, Amsterdam, the Netherlands.
Purpose:
To evaluate cost-effectiveness of the ACTIVE intervention aimed at supporting working-age knee arthroplasty patients in resuming daily life activities.
Methods:
We performed an economic evaluation (societal and healthcare perspectives) alongside the multicenter randomized-controlled ACTIVE trial. Eligible patients were of working-age, awaiting knee arthroplasty, employed ≥8 h/week, and willing to return to work. Patients received usual care or the personalized ACTIVE intervention including the iRecover-app with activity tracker, case-manager consultation and goal attainment scaling. Cost and effects were measured up to one year postoperatively. Effects were expressed in quality-adjusted life years (QALYs) and recovery of daily life activities (PROMIS-PF). Resource use was self-reported and converted into euros according to the Dutch manual for costing.
Results:
Of 287 randomized knee arthroplasty patients (145 intervention, 142 control), 265 (92%) analyzed (132 intervention, 133 control). Intervention patients resumed activities on average 37 (95% confidence interval: -55-18] days earlier than controls, at an incremental cost of €34 per day. Albeit all non-statistically significant, while QALY gains were observed in the intervention group compared with the control group (mean 0.021,95%CI: -0.008-0.049), mean total societal costs were higher (€1491, -3349-6331), with a low to moderate probability (0.48) of cost-effectiveness from a societal perspective. Contrary, from a healthcare perspective, the intervention demonstrated a high probability (0.84) of being cost-effective at the Dutch willingness-to-pay threshold of €50,000/QALY.
Conclusion:
The intervention led to earlier recovery of daily life activities and showed promising cost-effectiveness from a healthcare perspective. High absenteeism costs limited cost-effectiveness from a societal perspective.
Trial Registration:
NL8525.
