OBJECTIVES: Economic evaluations predominantly focus on generic outcomes measures such as EQ-5D. However, these methodologies are less prone to embrace the full spectrum of patient relevant domains. With the transition to patient-centered and remote care delivery, we aim to truly integrate patient's perspective of value within a cost-effectiveness analysis (CEA).

METHODS: A decision tree analysis regarding a retrospective study in the period 2020-2021 was conducted to perform a CEA comparing electronic consultations (e-consultations) and physical consultations in Rheumatoid Arthritis (RA) patients. Real world data of 772 patients were used to assess the difference in terms of cost-effectiveness from a patient and generic perspective with a time horizon of one year. The Incremental Cost-Effectiveness Ratio (ICER) expressed in EQ-5D was compared to the Health Assessment Questionnaire-Disability Index (HAQ-DI) and Rheumatoid Arthritis Impact of Disease (RAID) to capture the patient perspective in value measurements as complement to the ISPOR “value flower”. HAQ-DI scores were transformed to EQ-5D scores and correlations between the HAQ-DI and RAID were calculated using a Pearson correlation coefficient.

RESULTS: E-consultations were the dominant strategy with an ICER of − €102,341/QALY(HAQ-DI), − €10,771/RAID and − €103,191/QALY(EQ-5D). Patient health outcomes of e-consultations were on average better when compared to physical consultations. However, no statistical differences were present (HAQ-DI, p=0.285; RAID, p=0.176; EQ-5D, p=0.545). A moderate strong correlation was found between HAQ-DI and RAID scores (r=0.61, p<0.01). Cost savings in the e-consultation group totaled €949,- per patient. Sensitivity analyses from a societal perspective corresponded to cost savings of €1061,- .

CONCLUSIONS: ICERs of the transformed HAQ-DI and generic outcome (EQ-5D) yields similar results. As HAQ-DI incorporates the patient perspective within CEA, this outcome measure is thus preferred over generic ones. A next step entails transformation of RAID scores to allow comparisons of patient-reported outcomes in disease-specific and -transcending fields.