title: Cost implications of self-management education intervention programmes in arthritis.
abstract: The purpose of this review is to examine cost implications, including cost-effectiveness analyses, cost-savings calculated from health-care utilisation and intervention delivery costs of arthritis-related self-management education (SME) interventions.
  
  
  METHODS
  Literature searches, covering 1980-March 2012, using arthritis, self-management and cost-related terms, identified 487 articles; abstracts were reviewed to identify those with cost information.
  
  
  RESULTS
  Three formal cost-effectiveness analyses emerged; results were equivocal but analyses done from the societal perspective, including out-of-pocket and other indirect costs, were more promising. Eight studies of individual, group and telephone-delivered SME calculated cost-savings based on health-care utilisation changes. These studies had variable results but the costs-savings extrapolation methods are questionable. Meta-analyses of health-care utilisation changes in two specific SME interventions demonstrated only one significant result at 6 months, which did not persist at 12 months. Eleven studies reported intervention delivery costs ranging from $35 to $740 per participant; the variability is likely due to costing methods and differences in delivery mode.
  
  
  CONCLUSIONS
  Economic analysis in arthritis-related SME is in its infancy; more robust economic evaluations are required to reach sound conclusions. The most common form of analysis used changes in health-care utilisation as a proxy for cost-savings; the results are less than compelling. However, other value metrics, including the value of SME as part of health systems' self-management support efforts, to population health (from improved self-efficacy, psychological well-being and physical activity), and to igniting patient activation, are all important to consider.
authors.affiliation: Arthritis Program, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MS K-51, Atlanta, GA 30341, USA. tob9@cdc.gov
authors.forename: Teresa J
authors.initials: TJ
authors.lastname: Brady
mesh_terms: D001168:Arthritis / Q000191:economics / Q000628:therapy*; D003365:Costs and Cost Analysis; D006801:Humans; D010353:Patient Education as Topic / Q000191:economics*; D015397:Program Evaluation / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000191:economics*