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

Thorn, J. et al. (2020) Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial. BMJ Open, 10(1), e030110. (doi: 10.1136/bmjopen-2019-030110) (PMID:31959601) (PMCID:PMC7044971)

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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

Item Type:Articles
Additional Information:This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (project number 12/130/15). This study was designed and conducted in collaboration with the Bristol Randomised Trials Collaboration (BRTC), a UKCRC Registered clinical trials unit (CTU) in receipt of NIHR CTU support funding. CS is partly supported by The NIHR Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) and by Bristol Clinical Commissioning Group.
Glasgow Author(s) Enlighten ID:Mercer, Professor Stewart and Fitzpatrick, Dr Bridie
Authors: 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., and Salisbury, C.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
Published Online:19 January 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in BMJ Open 10(1)::e030110
Publisher Policy:Reproduced under a Creative Commons License

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