Abstract:
Objective
To conduct a cost-utility analysis on an integrated healthcare model comprising an assigned internist and a hospital liaison nurse for patients with multimorbidity, compared to a conventional reactive healthcare system.
Methods
A cluster randomised clinical trial was conducted. The model consisted of a reference internist and a liaison nurse, who aimed to improve coordination and communication between levels and to enhance continuity of care after hospitalisation. We recorded sociodemographic data, diagnoses and corresponding clinical categories, functional status, use of healthcare resources and quality of life. Data were collected by reviewing electronic medical records and administering questionnaires. We performed univariate and multivariate analyses both for utilities and total costs. Bootstrapping methods were applied to calculate the confidence ellipses of incremental costs and efficiency.
Keywords
Comorbidity; Cost-benefit analysis; Integrated healthcare; Clinical trial
Results
We recruited a total of 140 patients. The model assessed was not found to be efficient in general. We found an incremental cost of €1,035.90 and an incremental benefit of −0.0762 QALYs for the initiative compared to standard care after adjusting for the main variables. However, the subgroup of patients under 80 years of age with three or more clinical categories resulted in an 89% cost saving in the simulations.
Citation: Itziar Lanzetaa, Javier Mar, Arantzazu Arrospide Cost-utility Analysis Of An Integrated Care Model For Multimorbid Patients Based On A Clinical Trial http://dx.doi.org/10.1016/j.gaceta.2016.05.002
Received: 2 February 2016, Accepted: 3 May 2016, Available: online 29 June 2016
Copyright: © 2016 Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Conclusions
The integrated model was not suitable for all study patients. However, the subgroup analysis identified a narrow target population that should be analysed in future studies.
Funding
None.
Conflict of interest
None.
Acknowledgments
We would like to acknowledge the editorial assistance provided by Ideas Need Communicating Language Services.
