Digital self-management programme for pain, fatigue and faecal incontinence in inflammatory bowel disease: cost-effectiveness analysis of the IBD-BOOST randomised controlled trial
Chris Roukas, Laura Miller, Fionn Cléirigh Büttner, Thomas Hamborg, Vladimir Sergeevich Gordeev, Vari Wileman, Richard C G Pollok, Sonia Saxena, Rona Moss-Morris, Ailsa Hart, James O Lindsay, Christine Norton, Borislava MihaylovaObjective
People living with inflammatory bowel disease (IBD) frequently experience abdominal pain, fatigue and faecal incontinence that persist despite optimal medical treatment. This study aimed to assess the cost-effectiveness of IBD-BOOST, a digital, interactive, facilitator-supported self-management intervention targeting these symptoms.
Methods
A cost-effectiveness analysis was conducted alongside the IBD-BOOST trial, which randomised people with IBD experiencing fatigue, pain and/or faecal incontinence to the IBD-BOOST intervention (N=391) or care as usual (N=389) over 12 months. While the IBD-BOOST intervention did not significantly improve the primary trial outcome measures (UK Inflammatory Bowel Disease Questionnaire and global rating of symptom relief), trends towards benefit were observed across study outcomes. Therefore, this analysis focuses on secondary health economic outcome measures. The cost of the intervention, including its development, facilitation and delivery, was assessed. Participants reported their health service use, out-of-pocket expenses and time off work over the previous 3 months and their health-related quality of life at baseline, 6-month and 12-month follow-up. Participants’ costs (2023 UK£) and quality-adjusted life years (QALYs) over the 12 months were compared between study arms using mixed effects models.
Results
The IBD-BOOST intervention resulted in additional per participant 0.016 QALYs (95% CI 0.002 to 0.030) over the 12 months in the study and cost savings of −£304.66 (−803.51 to 194.18) for healthcare and −£39.48 (−388.09 to 309.12) for out-of-pocket costs and time off work over months 4–6 and 10–12. This resulted in cost savings of −£28 633 (95% CI −51 555 to 18 764) and −£33 568 (−64 421 to 26 198) per QALY gained with IBD-BOOST from health services and societal perspectives, respectively, and high probability of cost-effectiveness.
Conclusion
The IBD-BOOST intervention is highly likely to be cost-effective for the self-management of pain, fatigue and faecal incontinence in people living with IBD.
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