Abstract
ObjectivesTo investigate the long-term cost-effectiveness (measured as the ratio of incremental NHS cost to incremental quality-adjusted life years) of a telehealth intervention for patients with raised cardiovascular disease (CVD) risk.DesignA cohort simulation model developed as part of the economic evaluation conducted alongside the Healthlines randomised controlled trial.SettingPatients recruited through primary care, and intervention delivered via telehealth service.ParticipantsParticipants with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, and with at least 1 modifiable risk factor, individually randomised from 42 general practices in England.InterventionA telehealth service delivered over a 12-month period. The intervention involved a series of responsive, theory-led encounters between patients and trained health information advisors who provided access to information resources and supported medication adherence and coordination of care.Primary and secondary outcome measuresCost-effectiveness measured by net monetary benefit over the simulated lifetime of trial participants from a UK National Health Service perspective.ResultsThe probability that the intervention was cost-effective depended on the duration of the effect of the intervention. The intervention was cost-effective with high probability if effects persisted over the lifetime of intervention recipients. The probability of cost-effectiveness was lower for shorter durations of effect.ConclusionsThe intervention was likely to be cost-effective under a lifetime perspective.Trial registration numberISRCTN27508731; Results.
Highlights
Cardiovascular disease (CVD) is a prevalent long-term condition associated with substantial
A challenge in estimating the costeffectiveness of interventions intended to reduce CVD risk is that randomised controlled trials (RCTs) may have follow-up periods that are shorter than the period over which an intervention may affect CVD risk
This paper describes the development and analysis of a state transition cohort simulation cost-effectiveness model intended to estimate the expected net benefits of the Healthlines telehealth intervention over the lifetime of trial participants. This approach is consistent with the principles of economic evaluation,[9] guidance from the National Institute for Health and Care Excellence (NICE)[10] and ISPOR guidelines[11] which recommend that cost-effectiveness analyses be undertaken over a time period that reflects differences in cost and effect attributable to an intervention or treatment
Summary
The probability that the intervention was costeffective depended on the duration of the effect of the intervention. The intervention was cost-effective with high probability if effects persisted over the lifetime of intervention recipients. The probability of costeffectiveness was lower for shorter durations of effect
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