Cost-effectiveness analysis for a tele-based health coaching program for chronic disease in primary care

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Abstract

Background

The burden of chronic disease and multimorbidity is rapidly increasing. Self-management support interventions are effective in reduce cost, especially when targeted at a single disease group; however, economical evidence of such complex interventions remains scarce. The objective of this study was to evaluate a cost-effectiveness analysis of a tele-based health-coaching intervention among patients with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF).

Methods

A total of 1570 patients were blindly randomized to intervention ( n = 970) and control ( n = 470) groups. The intervention group received monthly individual health coaching by telephone from a specially trained nurse for 12-months in addition to routine social and healthcare. Patients in the control group received routine social and health care. Quality of life was assessed at the beginning of the intervention and follow-up measurements were made after 12 months health coaching. The cost included all direct health-care costs supplemented with home care and nursing home-care costs in social care. Utility was based on a Health Related Quality of Life (HRQoL) measurement (15D instrument), and cost effectiveness was assessed using incremental cost-effectiveness ratios (ICERs).

Results

The cost-effectiveness of health coaching was highest in the T2D group (ICER €20,000 per Quality-Adjusted Life Years [QALY]). The ICER for the CAD group was more modest (€40,278 per QALY), and in the CHF group, costs increased with no marked effect on QoL. Probabilistic sensitivity analysis indicated that at the societal willingness to pay threshold of €50,000 per QALY, the probability of health coaching being cost effective was 55% in the whole study group.

Conclusions

The cost effectiveness of health coaching may vary substantially across patient groups, and thus interventions should be targeted at selected subgroups of chronically ill. Based on the results of this study, health coaching improved the QoL of T2D and CAD patients with moderate costs. However, the results are grounded on a short follow-up period, and more evidence is needed to evaluate the long-term outcomes of health-coaching programs.

Trial registration

NCT00552903 [Prospectively registered, registration date 1 ^st November 2007, last updated 3 ^rd February 2009].

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Most cited references 18

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The effects of health coaching on adult patients with chronic diseases: a systematic review.

Kirsi Kivelä, Satu Elo, Helvi Kyngäs … (2014)

The aim of this systematic review was to describe the effects of health coaching on adult patients with chronic diseases.

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Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis

Maria Panagioti, Gerry Richardson, Nicola Small … (2014)

Background There is increasing interest in the role of ‘self-management’ interventions to support the management of long-term conditions in health service settings. Self-management may include patient education, support for decision-making, self-monitoring and psychological and social support. Self-management support has potential to improve the efficiency of health services by reducing other forms of utilisation (such as primary care or hospital use), but a shift to self-management may lead to negative outcomes, such as patients who feel more anxious about their health, are less able to cope, or who receive worse quality of care, all of which may impact on their health and quality of life. We sought to determine which models of self-management support are associated with significant reductions in health services utilisation without compromising outcomes among patients with long-term conditions. Methods We used systematic review with meta-analysis. We included randomised controlled trials in patients with long-term conditions which included self-management support interventions and reported measures of service utilisation or costs, as well as measures of health outcomes (standardized disease specific quality of life, generic quality of life, or depression/anxiety).We searched multiple databases (CENTRAL, CINAHL, Econlit, EMBASE, HEED, MEDLINE, NHS EED and PsycINFO) and the reference lists of published reviews. We calculated effects sizes for both outcomes and costs, and presented the results in permutation plots, as well as conventional meta-analyses. Results We included 184 studies. Self-management support was associated with small but significant improvements in health outcomes, with the best evidence of effectiveness in patients with diabetic, respiratory, cardiovascular and mental health conditions. Only a minority of self-management support interventions reported reductions in health care utilisation in association with decrements in health. Evidence for reductions in utilisation associated with self-management support was strongest in respiratory and cardiovascular problems. Studies at higher risk of bias were more likely to report benefits. Conclusions Self-management support interventions can reduce health service utilization without compromising patient health outcomes, although effects were generally small, and the evidence was strongest in respiratory and cardiovascular disorders. Further work is needed to determine which components of self-management support are most effective. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-356) contains supplementary material, which is available to authorized users.

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A comparison of the Assessment of Quality of Life (AQoL) with four other generic utility instruments.

Emily A. Day, Andrea Richardson, G Hawthorne (2001)

As part of the validation of the Assessment of Quality of Life (AQoL) instrument comparisons were made between five multiattribute utility (MAU) instruments, each purporting to measure health-related quality of life (HRQoL). These were the AQoL, the Canadian Health Utilities Index (HUI) 3, the Finnish 15D, the EQ-5D (formerly the EuroQoL) and the SF6D (derived from the SF-36). The paper compares absolute utility scores, instrument sensitivity, and incremental differences in measured utility between different instruments predicted by different individuals. The AQoL predicted utilities are similar to those from the HUI3 and EQ-5D. By contrast the 15D and SF6D predict systematically higher utilities, and the differences between individuals are significantly smaller. There is some evidence that the AQoL has greater sensitivity to health states than other instruments. It is concluded that at present no single MAU instrument can claim to be the 'gold standard', and that researchers should select an instrument sensitive to the health states they are investigating. Caution should be exercised in treating any of the instrument scores as representing a trade-off between length of life and HRQoL.

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Author and article information

Contributors

Erja Oksman:

ORCID: http://orcid.org/0000-0001-5304-9121

erja.oksman@phsotey.fi

Miika Linna: mika.linna@aalto.fi

Iiris Hörhammer: iiris.horhammer@aalto.fi

Johanna Lammintakanen: johanna.lammintakanen@uef.fi

Martti Talja: martti.talja@eduskunta.fi

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 15 February 2017

Publication date PMC-release: 15 February 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 138

Affiliations

[1 ]Päijät-Häme Social and Health Care District, Keskussairaalankatu 7, 15 850 Lahti, Finland

[2 ]ISNI 0000000108389418, GRID grid.5373.2, Healthcare Engineering, , Management and Architecture Institute, Aalto University, ; Espoo, Finland

[3 ]ISNI 0000 0001 0726 2490, GRID grid.9668.1, Department of Social and Health Management, , University of Eastern Finland, ; Joensuu, Finland

Author information

Erja Oksman http://orcid.org/0000-0001-5304-9121

Article

Publisher ID: 2088

DOI: 10.1186/s12913-017-2088-4

PMC ID: 5312514

PubMed ID: 28202032

SO-VID: be0ee9c5-ce52-4559-a11e-f256604f622d

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 23 June 2016

Date accepted : 10 February 2017

Funding

Funded by: Päijät-Häme Central Hospital (EVO: Special State Funding)

Award ID: VRT17022015

Award Recipient : Erja Oksman

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: health coaching,self-management,cost-effectiveness,chronic disease,15d,health-related quality of life

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ScienceOpen disciplines: Health & Social care

Keywords: health coaching, self-management, cost-effectiveness, chronic disease, 15d, health-related quality of life

Cost-effectiveness analysis for a tele-based health coaching program for chronic disease in primary care

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Most cited references 18

The effects of health coaching on adult patients with chronic diseases: a systematic review.

Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis

A comparison of the Assessment of Quality of Life (AQoL) with four other generic utility instruments.

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