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Thorn, Joanna, Man, Mei-See 
ORCID: https://orcid.org/0000-0003-4948-5670, Chaplin, Katherine, Bower, Peter, Brookes, Sara, Gaunt, Daisy, Fitzpatrick, Bridie, Gardner, Caroline, Guthrie, Bruce, Hollinghurst, Sandra, Lee, Victoria, Mercer, Stewart W. and Salisbury, Chris
(2020)
Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial.
BMJ Open, 10 (1).
ISSN 2044-6055
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Abstract
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 pound (-739 pound to 991)) pound in the intervention arm compared with usual care after 15 months. The incremental cost-effectiveness ratio was 18 pound 499, with a 50.8% chance of being cost-effective at a willingness-to-pay threshold of 20 pound 000 per QALY (55.8% at 30 pound 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | definition,intervention,economic evaluation,multimorbidity,patient-centred care,primary care,sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Centres > Population Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 28 Jan 2020 03:53 |
| Last Modified: | 25 Sep 2024 14:27 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/73824 |
| DOI: | 10.1136/bmjopen-2019-030110 |
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