Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial
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 impr...
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BMJ Publishing Group
2020-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/1/e030110.full |
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| author | Peter Bower Bruce Guthrie Stewart W Mercer Daisy Gaunt Sara Brookes Joanna Thorn Chris Salisbury Mei-See Man Katherine Chaplin Bridie Fitzpatrick Caroline Gardner Sandra Hollinghurst Victoria Lee |
| author_facet | Peter Bower Bruce Guthrie Stewart W Mercer Daisy Gaunt Sara Brookes Joanna Thorn Chris Salisbury Mei-See Man Katherine Chaplin Bridie Fitzpatrick Caroline Gardner Sandra Hollinghurst Victoria Lee |
| author_sort | Peter Bower |
| collection | DOAJ |
| description | 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 |
| format | Article |
| id | doaj-art-5d7f1b20bd5b4de6a3d26b014ee5d9b8 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-5d7f1b20bd5b4de6a3d26b014ee5d9b82024-12-06T09:40:08ZengBMJ Publishing GroupBMJ Open2044-60552020-01-0110110.1136/bmjopen-2019-030110Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trialPeter Bower0Bruce Guthrie1Stewart W Mercer2Daisy Gaunt3Sara Brookes4Joanna Thorn5Chris Salisbury6Mei-See Man7Katherine Chaplin8Bridie Fitzpatrick9Caroline Gardner10Sandra Hollinghurst11Victoria Lee12professor of health services researchUsher Institute, University of Edinburgh, Edinburgh Medical School, Edinburgh, UKInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UKBristol Trials Centre, University of Bristol, Bristol, UK7 Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK1 Bristol Trials Centre, University of Bristol, Bristol, UKCentre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UKNorwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK1 Centre for Academic Primary Care, School of Population Health Sciences, University of Bristol, Bristol, UKInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UKNIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UKsenior lecturer2 WHOOP, Boston, Massachusetts, USAObjective 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 ISCRTN06180958https://bmjopen.bmj.com/content/10/1/e030110.full |
| spellingShingle | Peter Bower Bruce Guthrie Stewart W Mercer Daisy Gaunt Sara Brookes Joanna Thorn Chris Salisbury Mei-See Man Katherine Chaplin Bridie Fitzpatrick Caroline Gardner Sandra Hollinghurst Victoria Lee Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial BMJ Open |
| title | Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial |
| title_full | Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial |
| title_fullStr | Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial |
| title_full_unstemmed | Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial |
| title_short | Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial |
| title_sort | cost effectiveness of a patient centred approach to managing multimorbidity in primary care a pragmatic cluster randomised controlled trial |
| url | https://bmjopen.bmj.com/content/10/1/e030110.full |
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