AI Article Synopsis
- - The study evaluated the cost-effectiveness of a new care model called the 3D intervention, designed to streamline the management of patients with multiple chronic health conditions in primary care settings.
- - Participants included 797 adults receiving the 3D intervention and 749 individuals receiving standard care, with outcomes assessed over 15 months in terms of quality-adjusted life years (QALYs) and associated costs.
- - Results showed minimal differences in QALYs and costs between the two groups, suggesting that the 3D approach may not be significantly more cost-effective than usual care, highlighting substantial uncertainty in the findings.
Article 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 (£-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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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044971 | PMC |
| http://dx.doi.org/10.1136/bmjopen-2019-030110 | DOI Listing |
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