Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial

Joanna Thorn; Mei-See Man; Katherine Chaplin; Peter Bower; Sara Brookes; Daisy Gaunt; Bridie Fitzpatrick; Caroline Gardner; Bruce Guthrie; Sandra Hollinghurst; Victoria Lee; Stewart W Mercer; Chris Salisbury

doi:10.1136/bmjopen-2019-030110

Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial

Joanna Thorn, Mei-See Man, Katherine Chaplin, Peter Bower, Sara Brookes, Daisy Gaunt, Bridie Fitzpatrick, Caroline Gardner, Bruce Guthrie, Sandra Hollinghurst, Victoria Lee, Stewart W Mercer, Chris Salisbury

Norwich Medical School

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

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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.

Original language	English
Article number	030110
Number of pages	10
Journal	BMJ Open
Volume	10
Issue number	1
DOIs	https://doi.org/10.1136/bmjopen-2019-030110
Publication status	Published - 19 Jan 2020

Keywords

DEFINITION
INTERVENTION
economic evaluation
multimorbidity
patient-centred care
primary care

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/bmjopen-2019-030110Licence: CC BY

Published_VersionFinal published version, 614 KBLicence: CC BY

Cite this

Thorn, J., Man, M-S., Chaplin, K., Bower, P., Brookes, S., Gaunt, D., Fitzpatrick, B., Gardner, C., Guthrie, B., Hollinghurst, S., Lee, V., Mercer, S. W., & Salisbury, C. (2020). Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial. BMJ Open, 10(1), [030110]. https://doi.org/10.1136/bmjopen-2019-030110

Thorn, Joanna ; Man, Mei-See ; Chaplin, Katherine ; Bower, Peter ; Brookes, Sara ; Gaunt, Daisy ; Fitzpatrick, Bridie ; Gardner, Caroline ; Guthrie, Bruce ; Hollinghurst, Sandra ; Lee, Victoria ; Mercer, Stewart W ; Salisbury, Chris. / Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial. In: BMJ Open. 2020 ; Vol. 10, No. 1.

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title = "Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial",

abstract = "ObjectivePatients 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.DesignEconomic evaluation conducted alongside a pragmatic cluster-randomised trial.SettingGeneral practices in three centres in England and Scotland.Participants797 adults with three or more chronic conditions were randomised to the 3D intervention, while 749 participants were randomised to receive usual care.InterventionThe 3D approach: comprehensive 6-monthly general practitioner consultations, supported by medication reviews and nurse appointments.Primary and secondary outcome measuresThe 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.ResultsVery 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).ConclusionsThe 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.",

keywords = "DEFINITION, INTERVENTION, economic evaluation, multimorbidity, patient-centred care, primary care",

author = "Joanna Thorn and Mei-See Man and Katherine Chaplin and Peter Bower and Sara Brookes and Daisy Gaunt and Bridie Fitzpatrick and Caroline Gardner and Bruce Guthrie and Sandra Hollinghurst and Victoria Lee and Mercer, {Stewart W} and Chris Salisbury",

note = "{\textcopyright} Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.",

year = "2020",

month = jan,

day = "19",

doi = "10.1136/bmjopen-2019-030110",

language = "English",

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Thorn, J, Man, M-S, Chaplin, K, Bower, P, Brookes, S, Gaunt, D, Fitzpatrick, B, Gardner, C, Guthrie, B, Hollinghurst, S, Lee, V, Mercer, SW & Salisbury, C 2020, 'Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial', BMJ Open, vol. 10, no. 1, 030110. https://doi.org/10.1136/bmjopen-2019-030110

Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial. / Thorn, Joanna; Man, Mei-See; Chaplin, Katherine; Bower, Peter; Brookes, Sara; Gaunt, Daisy; Fitzpatrick, Bridie; Gardner, Caroline; Guthrie, Bruce; Hollinghurst, Sandra; Lee, Victoria; Mercer, Stewart W; Salisbury, Chris.

In: BMJ Open, Vol. 10, No. 1, 030110, 19.01.2020.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial

AU - Thorn, Joanna

AU - Man, Mei-See

AU - Chaplin, Katherine

AU - Bower, Peter

AU - Brookes, Sara

AU - Gaunt, Daisy

AU - Fitzpatrick, Bridie

AU - Gardner, Caroline

AU - Guthrie, Bruce

AU - Hollinghurst, Sandra

AU - Lee, Victoria

AU - Mercer, Stewart W

AU - Salisbury, Chris

PY - 2020/1/19

Y1 - 2020/1/19

N2 - ObjectivePatients 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.DesignEconomic evaluation conducted alongside a pragmatic cluster-randomised trial.SettingGeneral practices in three centres in England and Scotland.Participants797 adults with three or more chronic conditions were randomised to the 3D intervention, while 749 participants were randomised to receive usual care.InterventionThe 3D approach: comprehensive 6-monthly general practitioner consultations, supported by medication reviews and nurse appointments.Primary and secondary outcome measuresThe 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.ResultsVery 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).ConclusionsThe 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.

AB - ObjectivePatients 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.DesignEconomic evaluation conducted alongside a pragmatic cluster-randomised trial.SettingGeneral practices in three centres in England and Scotland.Participants797 adults with three or more chronic conditions were randomised to the 3D intervention, while 749 participants were randomised to receive usual care.InterventionThe 3D approach: comprehensive 6-monthly general practitioner consultations, supported by medication reviews and nurse appointments.Primary and secondary outcome measuresThe 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.ResultsVery 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).ConclusionsThe 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.

KW - DEFINITION

KW - INTERVENTION

KW - economic evaluation

KW - multimorbidity

KW - patient-centred care

KW - primary care

UR - https://doi.org/10.1136/bmjopen-2019-030110

UR - http://www.scopus.com/inward/record.url?scp=85078418618&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2019-030110

DO - 10.1136/bmjopen-2019-030110

M3 - Article

C2 - 31959601

VL - 10

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 1

M1 - 030110

ER -

Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial

Abstract

Keywords

UN SDGs

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