Cost-effectiveness of motivational counselling and text reminders in patients with rheumatoid arthritis: results based on a randomised clinical trial

RMD Open. 2022 Jul;8(2):e002304. doi: 10.1136/rmdopen-2022-002304.


Objective: The aim of this study was to evaluate the cost-effectiveness of an individually tailored intervention consisting of motivational counselling and text message reminders to reduce sedentary behaviour in comparison with usual lifestyle in patients with rheumatoid arthritis (RA).

Methods: RA patients (n=150) were randomised to the intervention or control group. Costs of the intervention and healthcare utilisation during a 22-month follow-up period were reported. Outcomes were objectively measured as 24 hours/7 days sitting time and self-reported Health Assessment Questionnaire (HAQ) and EQ-5D scores at baseline, and 16 weeks, 10 and 22 months after baseline. Cost-effectiveness was reported as incremental cost-effectiveness ratios and statistical uncertainty presented as cost-effectiveness acceptability curves.

Results: The intervention cost was estimated at €387 per participant. The mean incremental 22-month healthcare cost was €-1165 (95% bootstrap CI -5613 to 3283). An incremental 20%-point of the participants (CI 10.4% to 29.6%) reduced their daily sitting time more than 50 min and 36%-point reported better HAQ scores (change>0.22). The time-weighted health utilities (quality-adjusted life years (QALYs)) increased by 0.10 (CI 0.02 to 0.18) and 0.11 (CI 0.04 to 0.19) for EQ-5D index and EQ-VAS, respectively. The intervention dominated usual lifestyle by offering better outcomes and lower costs. With a threshold value of €30 000/QALY the intervention has a probability of 95% of being cost-effective.

Conclusion: This protocolised cost-effectiveness analysis showed that an individually tailored intervention aimed at reducing sedentary behaviour in patients with RA is improving participants' 22-month health status and reducing healthcare costs. These results suggest that the intervention should be implemented in routine rheumatology care.

Trial registration number: NCT01969604.

Keywords: Arthritis, Rheumatoid; Economics; Health services research; Patient Reported Outcome Measures.

Publication types

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

MeSH terms

  • Arthritis, Rheumatoid* / therapy
  • Cost-Benefit Analysis
  • Counseling
  • Humans
  • Sedentary Behavior
  • Text Messaging*

Associated data