To evaluate the cost-utility and cost-effectiveness of the dr. Bart app compared to usual care in people with knee/hip OA, applying a health care payer perspective.
This economic evaluation was conducted alongside a 6-month randomized controlled trial, involving 427 participants. The dr. Bart app is a stand-alone eHealth application which invites users to select pre-formulated goals (i.e. "tiny habits") and triggers to a healthier lifestyle. Self-reported outcome measures were health care costs, quality-adjusted life years (QALYs) according to the EuroQol (EQ-5D-3L), and the EuroQol Visual Analogue Scale (QALY-VAS), patient activation measure (PAM-13) and five subscales of KOOS/HOOS. Missing data were multiply imputed and bootstrapping was used to estimate statistical uncertainty.
Mean age of participants was 62.1(SD 7.3) years, with the majority being female(72%). Health care costs were lower for the intervention group(€-22 (95% CI: -36; -3)). For QALY and QALY-VAS, the probability of the dr. Bart app being cost-effective compared to usual care was 0.71 and 0.67 at a willingness to pay(WTP) of €10.000 and 0.64 and 0.56 at WTP €80.000, respectively. For self-management behaviour, symptoms, pain and ADL, the probability that dr. Bart app was cost-effective was >0.82 and for activities and quality of life <0.40, regardless of WTPs.
This economic evaluation showed that costs were lower for the dr. Bart app group compared to usual care. Given the non-invasive character of the intervention and the moderate probability of being cost-effective for the majority of outcomes, the dr. Bart app has the potential to serve as a tool to provide education and goal setting regarding OA and its treatment options.