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Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster
Joanna Thorn1, Mei-See Man2,3, Katherine Chaplin2
1Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK joanna.thorn@bristol.ac.uk.
Objective:
Patients with multiple chronic health conditions are often managed in a disjointed fashion in primary care, with annual review clinic appointments offered separately for each condition. This study aimed to determine the cost-effectiveness of the 3D intervention, which was developed to improve the system of care.
Design:
Economic evaluation conducted alongside a pragmatic cluster-randomised trial.
Setting:
General practices in three centres in England and Scotland.
Participants:
797 adults with three or more chronic conditions were randomised to the 3D intervention, while 749 participants were randomised to receive usual care.
Intervention:
The 3D approach: comprehensive 6-monthly general practitioner consultations, supported by medication reviews and nurse appointments.
Primary And Secondary Outcome Measures:
The primary economic evaluation assessed the cost per quality-adjusted life year (QALY) gained from the perspective of the National Health Service (NHS) and personal social services (PSS). Costs were related to changes in a range of secondary outcomes (QALYs accrued by both participants and carers, and deaths) in a cost-consequences analysis from the perspectives of the NHS/PSS, patients/carers and productivity losses.
Results:
Very small increases were found in both QALYs (adjusted mean difference 0.007 (-0.009 to 0.023)) and costs (adjusted mean difference £126 (£-739 to £991)) in the intervention arm compared with usual care after 15 months. The incremental cost-effectiveness ratio was £18 499, with a 50.8% chance of being cost-effective at a willingness-to-pay threshold of £20 000 per QALY (55.8% at £30 000 per QALY).
Conclusions:
The small differences in costs and outcomes were consistent with chance, and the uncertainty was substantial; therefore, the evidence for the cost-effectiveness of the 3D approach from the NHS/PSS perspective should be considered equivocal.
Trial Registration Number:
ISCRTN06180958.
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