Lifestyle app lowers costs, sets goals for patients with hip, knee OA
A standalone, healthy lifestyle app, called dr. Bart, can lower costs, compared with usual care, and help provide education and goal setting for patients with osteoarthritis, according to data published in Arthritis Care & Research.
“Due to the considerable costs related to OA, there is need for cost-effective interventions in the treatment for people with knee/hip OA,” Tim Pelle, PhD, PT, of Sint Maartenskliniek and Radboud University Medical Center, in Nijmegen, the Netherlands, and colleagues wrote. “Given the huge potential of eHealth technologies, we developed the dr. Bart app to enhance self-management in people with knee/hip OA. The dr. Bart app is based on the Fogg model for behavioral change, augmented with reminders, rewards and self-monitoring to reinforce app engagement.”
Although prior evaluations found no link between the app’s use and changes in health care use over 6 months, dr. Bart did demonstrate small but positive effects on pain, symptoms and activities of daily life in people with knee or hip OA, according to the researchers.
“Given the scarce health resources, the growing economic burden as a consequence of rising prevalence of OA and the fact that prior studies did not assess joint uncertainty around cost and effects it is important to conduct an economic evaluation,” Pelle and colleagues wrote. “Moreover, to be implemented on a larger scale, insight in the cost-effectiveness is warranted.”
To analyze the cost utility and effectiveness of the dr. Bart app, compared with usual care, in, and from the perspective of, patients with knee or hip OA, Pelle and colleagues conducted an economic evaluation alongside a 6-month randomized controlled trial. The aim of the randomized controlled trial was to examine the app’s impact on 6-month health care use and clinical outcomes at Sint Maartenskliniek from 2018 to 2019. The economic evaluation included 427 trial participants, with 214 assigned to the dr. Bart app and 213 allocated to the usual care group.
In the dr. Bart group, the app proposed goals for a healthier lifestyle, based on machine learning using data collected in a personal profile and the prior behavior of the user. The app additionally used reminders, rewards and self-monitoring to reinforce engagement and health behavior. In the usual care group, patients received no active treatment. After completing the last follow-up questionnaire, these participants were offered the dr. Bart app.
Self‐reported outcome measures included health care costs, quality‐adjusted life years (QALYs) — based on the EuroQol (EQ‐5D‐3L) and the EuroQol Visual Analogue Scale (QALY‐VAS) — patient activation measure (PAM‐13), and five subscales of the Knee/Hip injury and Osteoarthritis Outcome Score (KOOS/HOOS). The researchers used bootstrapping to estimate statistical uncertainty in their analysis.
According to the researchers, health care costs were lower in the dr. Bart group (group difference = –22 euros; 95% CI, –36 to –3), compared with patients who received usual care. Regarding QALY and QALY‐VAS, the probability that the dr. Bart app would be cost‐effective, compared to usual care, was 0.71 and 0.67 at a willingness to pay (WTP) of 10,000 euros, and 0.64 and 0.56 at a WTP of 80,000 euros, respectively. For self‐management behavior, symptoms, pain and activities of daily living, the probability that the app was cost‐effective was greater than 0.82 — and less than 0.4 for activities and quality of life — regardless of WTPs.
“This economic evaluation from a health care payer perspective shows moderate probability that an eHealth application to enhance self-management (dr. Bart app) in people with knee/hip can be considered cost-effective,” Pelle and colleagues wrote.
“In view of the prevalence of OA and the fact that inducing difficult lifestyle changes is the cornerstone of management of OA and therefore a potentially long-term investment, we think the magnitude of effects attributable to the dr. Bart app are worthwhile,” they added. “Thus, the app could be applied as primary approach to deliver useful information and support self-management in people with knee/hip OA, specifically for patients who are interested in eHealth.”