A trial-based economic evaluation of the CaFaSpA referral strategy for axial spondyloarthritis

M. Jamal*, T. M. Kuijper, J. M.W. Hazes, D. Lopes Barreto, A. E.A.M. Weel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review



To assess the cost–utility from healthcare and societal perspectives of the digital CaFaSpA referral strategy (CS) for axial spondyloarthritis (axSpA) in primary care patients with chronic low back pain (CLBP). 


A cluster randomized controlled trial was performed in the Netherlands. General practice units were randomized into CS or usual care (UC). Economic evaluation was performed from the healthcare and societal perspectives within a 12-month time horizon. Outcome measures encompassed disability [Roland–Morris Disability Questionnaire (RMDQ)] and health-related quality of life (EQ-5D-3L). Direct medical (iMTA Medical Consumption Questionnaire) and indirect costs (iMTA Productivity Cost Questionnaire), including productivity loss, were evaluated. Incremental cost–utility ratios (ICURs) were calculated. 


The study included 90 GP clusters with 563 patients (CS: n = 260; UC: n = 303) (mean ± sd age 36.3 ± 7.5 years; 66% female). After 12 months, no minimal important differences in outcomes were observed for RMDQ (−0.21, 95%CI −1.52 to 1.13) or EQ-5D (−0.02, 95%CI −0.08 to 0.05). However, total costs were significantly lower in the CS group owing to lower productivity loss costs. The ICUR for RMDQ was €18,059 per point decrease and €220,457 per quality-adjusted life year increase. 


Digital referral did not decrease the overall healthcare status of patients after 1 year of follow-up and appears to be more cost-effective than UC. Therefore, CS can be used as an appropriate primary care referral model for CLBP patients at risk for axSpA. This will accelerate timely provision of care by the right caregiver.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalScandinavian Journal of Rheumatology
Issue number1
Early online date31 Aug 2023
Publication statusPublished - 2024

Bibliographical note

Publisher Copyright:
© 2023 Scandinavian Journal of Rheumatology Foundation.


Dive into the research topics of 'A trial-based economic evaluation of the CaFaSpA referral strategy for axial spondyloarthritis'. Together they form a unique fingerprint.

Cite this