Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial Article Swipe
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
·
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1136/bmjopen-2019-030110
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1136/bmjopen-2019-030110
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
Related Topics
Concepts
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1136/bmjopen-2019-030110
- https://bmjopen.bmj.com/content/bmjopen/10/1/e030110.full.pdf
- OA Status
- gold
- Cited By
- 25
- References
- 37
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W2999652774
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W2999652774Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1136/bmjopen-2019-030110Digital Object Identifier
- Title
-
Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trialWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2020Year of publication
- Publication date
-
2020-01-01Full publication date if available
- Authors
-
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 SalisburyList of authors in order
- Landing page
-
https://doi.org/10.1136/bmjopen-2019-030110Publisher landing page
- PDF URL
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https://bmjopen.bmj.com/content/bmjopen/10/1/e030110.full.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
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https://bmjopen.bmj.com/content/bmjopen/10/1/e030110.full.pdfDirect OA link when available
- Concepts
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Medicine, Primary care, Cluster (spacecraft), Cluster randomised controlled trial, Randomized controlled trial, Family medicine, Alternative medicine, Multimorbidity, Chronic disease, Internal medicine, Pathology, Programming language, Computer scienceTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
25Total citation count in OpenAlex
- Citations by year (recent)
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2025: 6, 2024: 2, 2023: 3, 2022: 2, 2021: 10Per-year citation counts (last 5 years)
- References (count)
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37Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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