Economic evaluation of a brief education, self-management and upper limb exercise training in people with rheumatoid arthritis (EXTRA) programme: a trial-based analysis

Rheumatology (Oxford). 2015 Feb;54(2):302-9. doi: 10.1093/rheumatology/keu319. Epub 2014 Aug 29.


Objective: The aim of this study was to conduct a cost-utility analysis of the Education, Self-management and Upper Limb Exercise Training in People with RA (EXTRA) programme compared with usual care.

Methods: A within-trial incremental cost-utility analysis was conducted with 108 participants randomized to either the EXTRA programme (n = 52) or usual care (n = 56). A health care perspective was assumed for the primary analysis with a 36 week follow-up. Resource use information was collected on interventions, medication, primary and secondary care contacts, private health care and social care costs. Quality-adjusted life years (QALYs) were calculated from the EuroQol five-dimension three-level (EQ-5D-3L) questionnaire responses at baseline, 12 and 36 weeks.

Results: Compared with usual care, total QALYs gained were higher in the EXTRA programme, leading to an increase of 0.0296 QALYs. The mean National Health Service (NHS) costs per participant were slightly higher in the EXTRA programme (by £82), resulting in an incremental cost-effectiveness ratio of £2770 per additional QALY gained. Thus the EXTRA programme was cost effective from an NHS perspective when assessed against the threshold of £20 000-£30 000/QALY gained. Overall, costs were lower in the EXTRA programme compared with usual care, suggesting it was the dominant treatment option from a societal perspective. At a willingness-to-pay of £20 000/QALY gained, there was a 65% probability that the EXTRA programme was the most cost-effective option. These results were robust to sensitivity analyses accounting for missing data, changing the cost perspective and removing cost outliers.

Conclusion: The physiotherapist-led EXTRA programme represents a cost-effective use of resources compared with usual care and leads to lower health care costs and work absence.

Trial registration: International Standard Randomized Controlled Trial Number Register; (ISRCTN14268051).

Keywords: cost; cost–utility; economic evaluation; rheumatoid arthritis; self-management; upper limb exercise.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Arm
  • Arthritis, Rheumatoid / economics*
  • Arthritis, Rheumatoid / therapy
  • Cost of Illness
  • Cost-Benefit Analysis
  • Exercise Therapy / economics*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Education as Topic / economics*
  • Physical Therapists / economics
  • Quality of Life
  • Quality-Adjusted Life Years
  • Self Care / economics*
  • Treatment Outcome
  • Young Adult