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Personalized exercise plans appeared both beneficial and cost-effective in treating patients with chronic fatigue.
One major challenge of caring for patients with diseases like axial spondyloarthritis, systemic lupus erythematosus, and other inflammatory rheumatic conditions is the management of fatigue. Management of this symptom has been “suboptimal” in the past, according to researchers, opening the question of whether personalized cognitive behavioral approaches or physical activity interventions might help patients better manage their fatigue.
Exercise Routine as Fatigue Management
The addition of a personalized exercise plan to the usual standard of care appeared both beneficial and cost-effective in treating patients with chronic fatigue stemming from inflammatory rheumatic diseases, according to findings published in Rheumatology.
“In [rheumatoid arthritis], up to 80% of patients report significant fatigue, leading to impaired quality of life and work disability. For other inflammatory rheumatic diseases, fatigue prevalence is similar, ranging between 66 and 85%, and impacts on QOL and employment are equally pronounced,” Huey Yi Chong, PhD, of the Health Economics Research Unit at the Institute of Applied Health Sciences, University of Aberdeen, UK, and colleagues wrote. “A major problem, however, is that the patient experience with clinical management of fatigue is sub-optimal. There is now, however, growing recognition that non-pharmacological interventions, specifically cognitive-behavioral approaches (CBAs) and programs designed to support increased physical activity, can improve fatigue and health-related QOL.”
Dr. Chong and colleagues performed a within-trial economic evaluation of cognitive-behavioral and personalized exercise-plan approaches to fatigue management alongside the Lessening the Impact of Fatigue in Inflammatory Rheumatic, or LIFT, study. In the three-arm randomized, controlled trial, researchers randomly assigned patients to three different arms: usual care plus cognitive-behavioral approach, usual care plus personalized exercise plans, and usual care alone. “Usual care” in this study meant the use of an educational booklet distributed by the group Versus Arthritis, whereas the other interventions consisted of telephone-administered interventions. The study ran for 56 weeks. Researchers examined both the efficacy and cost-effectiveness of each intervention.
Personalized Exercise Plan More Effective Than Usual Care
The cognitive-behavioral intervention and personalized exercise plan were both more expensive than usual care, the researchers reported. The personalized exercise plan came with a mean adjusted cost difference of $715.39 (95% CI; $57.83-$836.09), according to Chong and colleagues, whereas the mean adjusted cost difference for the cognitive behavioral approach was $1,062.40 (95% CI; $901.47-$1,248.48), compared with usual care.
The authors noted that a personalized exercise plan was significantly more effective than a cognitive-behavioral intervention, with an adjusted mean quality-adjusted life year, or QALY, difference of 0.043 (95% CI; 0.019, 0.068) compared with usual care. For the cognitive-behavioral intervention, this difference was 0.001 (95% CI; −0.022-0.022) compared with usual care, they reported
The reported incremental cost-effectiveness ratio was $16,544.55 for the personalized exercise plan compared with usual care, whereas for the cognitive-behavioral approach, this ratio was $997,896.76 for cognitive-behavioral interventions versus usual care.
Personal exercise plans were reported to have an 88% probability of being cost effective when researchers set a threshold value of $25,143 per quality-adjusted life-year gained.
While both interventions appeared to relieve symptoms of fatigue, the researchers noted that there was “almost zero gain in health-related quality of life arising from the cognitive-behavioral intervention.” Chong and colleagues suggested that this may be related to differences in adherence between the two study groups, though an ad hoc analysis reportedly did not identify this as a factor.
“A personalized exercise plan generated greater gains in health-related quality of life than a cognitive-behavioral approach for the management of fatigue among patients with inflammatory rheumatic diseases,” the researchers concluded. “Further, using conventional WTP for quality-adjusted life-year gain thresholds, the addition of a personalized exercise plan alongside usual care alone is likely to provide a cost-effective use of health care resources.”
