TY - JOUR
T1 - Effectiveness and cost-effectiveness of a multimodal, physiotherapist-led, vocational intervention for people with rheumatoid arthritis or axial spondyloarthritis and a reduced work ability
T2 - a randomized, controlled trial
AU - Bakker, N. F.
AU - Knoop, J.
AU - Van Den Hout, W. B.
AU - Hutting, N.
AU - Engels, J. A.
AU - Staal, J. B.
AU - Van Der Leeden, M.
AU - Boonen, A.
AU - Willemze, A.
AU - Nurmohamed, M. T.
AU - Vliet Vlieland, T. P. M.
AU - Gademan, M. G. J.
AU - Van Weely, S. F. E.
PY - 2025/12/15
Y1 - 2025/12/15
N2 - To evaluate the (cost-)effectiveness of a physiotherapist-led, multimodal vocational intervention compared to usual care in adults with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) experiencing reduced work ability. (Self-)employed people with RA or axSpA and reduced work ability were randomized to a 12-month vocational intervention or usual care. Assessments were conducted at baseline, 3, 6, and 12 months. Primary outcome was the Work Ability index Single-item Scale (WAS) at 12 months. Secondary outcomes included additional work-related and clinical outcomes. Cost-effectiveness was evaluated using the EuroQol to estimate quality-adjusted life years (QALYs), alongside healthcare use and productivity data. Primary analyses followed an intention-to-treat approach. A total of 140 participants (80 RA, 60 axSpA) were randomized 1:1 to the intervention or control group. At 12 months, the intervention showed no significant benefits over usual care on the WAS (estimated mean difference (MD): 0.40, 95% confidence interval (CI): - 0.22, 1.01) or any of the secondary outcomes. The QALYs were in favor of the intervention group by 0.05. The mean intervention costs were 395 per participant (90% usage, mean 9.5 sessions). After 12 months, the societal costs were 4324 lower in the intervention group (95% CI -8169, -479), mainly due to higher medication and presenteeism costs in the control group. At a willingness-to-pay threshold of 20.000/QALY, the intervention had a 99% probability of being cost-effective compared to usual care. While the intervention did not affect work ability in individuals with RA or axSpA, it outperformed usual care from a health-economic perspective, demonstrating its cost-effectiveness and potential value. International Clinical Trial Registry Platform (ICTRP) registration link: ICTRP Search Portal.
AB - To evaluate the (cost-)effectiveness of a physiotherapist-led, multimodal vocational intervention compared to usual care in adults with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) experiencing reduced work ability. (Self-)employed people with RA or axSpA and reduced work ability were randomized to a 12-month vocational intervention or usual care. Assessments were conducted at baseline, 3, 6, and 12 months. Primary outcome was the Work Ability index Single-item Scale (WAS) at 12 months. Secondary outcomes included additional work-related and clinical outcomes. Cost-effectiveness was evaluated using the EuroQol to estimate quality-adjusted life years (QALYs), alongside healthcare use and productivity data. Primary analyses followed an intention-to-treat approach. A total of 140 participants (80 RA, 60 axSpA) were randomized 1:1 to the intervention or control group. At 12 months, the intervention showed no significant benefits over usual care on the WAS (estimated mean difference (MD): 0.40, 95% confidence interval (CI): - 0.22, 1.01) or any of the secondary outcomes. The QALYs were in favor of the intervention group by 0.05. The mean intervention costs were 395 per participant (90% usage, mean 9.5 sessions). After 12 months, the societal costs were 4324 lower in the intervention group (95% CI -8169, -479), mainly due to higher medication and presenteeism costs in the control group. At a willingness-to-pay threshold of 20.000/QALY, the intervention had a 99% probability of being cost-effective compared to usual care. While the intervention did not affect work ability in individuals with RA or axSpA, it outperformed usual care from a health-economic perspective, demonstrating its cost-effectiveness and potential value. International Clinical Trial Registry Platform (ICTRP) registration link: ICTRP Search Portal.
KW - Rheumatoid arthritis
KW - Axial spondyloarthritis
KW - Vocational rehabilitation
KW - Physical therapy modalities
KW - Cost-utility
KW - Randomized controlled trial
KW - REHABILITATION PROGRAM
KW - VALUING HEALTH
KW - SICK LEAVE
KW - PRODUCTIVITY
KW - IMPROVE
KW - BURDEN
KW - CARE
KW - QUESTIONNAIRE
KW - SYMPTOMS
KW - VALIDITY
U2 - 10.1007/s00296-025-06016-w
DO - 10.1007/s00296-025-06016-w
M3 - Article
SN - 0172-8172
VL - 46
JO - Rheumatology International
JF - Rheumatology International
IS - 1
M1 - 11
ER -