Journal Article

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

Oksman, Erja, Talja, Martti, Lammintakanen, Johanna, Linna, Miika, Hörhammer, Iiris

2017

Overview

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].

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Age / Aged / Antidiabetics / Cardiovascular disease / Care and treatment / Chronic Disease / Chronic diseases / Chronic illnesses / Clinical outcomes / Coaching / Coronary Artery Disease - economics / Coronary Artery Disease - nursing / Cost analysis / Cost estimates / Cost-Benefit Analysis / Diabetes / Diabetes Mellitus, Type 2 - economics / Diabetes Mellitus, Type 2 - nursing / Economic aspects / economics and financing systems / Electronic health records / expenditure / Female / Health Administration / Health care / Health Care Costs / Health care expenditures / Health Informatics / Health Promotion - economics / Health Promotion - methods / Heart failure / Heart Failure - economics / Heart Failure - nursing / Home Care Services - economics / Hospitals / Humans / Intervention / Laboratories / Male / Medicine / Medicine & Public Health / Mentoring - economics / Nursing Research / Patients / Primary care / Primary health care / Primary Health Care - economics / Public Health / Quality of Life / Quality-Adjusted Life Years / Questionnaires / Research Article / Self Care - economics / Sensitivity analysis / Software / Technology application / Telemedicine / Telemedicine - economics / Utilization