OBJECTIVE: To evaluate the cost-effectiveness of Anticipatory and Preventive Team Care (APTCare). DESIGN: Analysis of data drawn from a randomized controlled trial. SETTING: A family health network in a rural area near Ottawa, Ont. PARTICIPANTS: Patients 50 years of age or older at risk of experiencing adverse health outcomes. Analysis of cost-effectiveness was performed for a subsample of participants with at least 1 of the chronic diseases used in the quality of care (QOC) measure (74 intervention and 78 control patients). INTERVENTIONS:At-risk patients were randomly assigned to receive usual care from their family physicians or APTCare from a collaborative team. MAIN OUTCOME MEASURES: Cost-effectiveness and the net benefit to society of the APTCare intervention. RESULTS: Costs not directly associated with delivery of the intervention were similar in the 2 arms: $9121 and $9222 for the APTCare and control arms, respectively. Costs directly associated with the program were $3802 per patient for a total cost per patient of $12,923 and $9222, respectively (P=.033). A 1% improvement in QOC was estimated to cost $407 per patient. Analysis of the net benefit to society in absolute dollars found a breakeven threshold of $750 when statistical significance was required. This implies that society must place a value of at least $750 on a 1% improvement in QOC in order for the intervention to be socially worthwhile. By any of the metrics used, the APTCare intervention was not cost-effective, at least not in a population for which baseline QOC was high. CONCLUSION: Although our calculations suggest that the APTCare intervention was not cost-effective, our results need the following caveats. The costs of such a newly introduced intervention are bound to be higher than those for an established, up-and-running program. Furthermore, it is possible that some benefits of the secondary preventive measures were not captured in this limited 12- to 18-month study or were simply not measured. TRIAL REGISTRATION NUMBER NCT00238836 (CONSORT).
RCT Entities:
OBJECTIVE: To evaluate the cost-effectiveness of Anticipatory and Preventive Team Care (APTCare). DESIGN: Analysis of data drawn from a randomized controlled trial. SETTING: A family health network in a rural area near Ottawa, Ont. PARTICIPANTS: Patients 50 years of age or older at risk of experiencing adverse health outcomes. Analysis of cost-effectiveness was performed for a subsample of participants with at least 1 of the chronic diseases used in the quality of care (QOC) measure (74 intervention and 78 control patients). INTERVENTIONS: At-risk patients were randomly assigned to receive usual care from their family physicians or APTCare from a collaborative team. MAIN OUTCOME MEASURES: Cost-effectiveness and the net benefit to society of the APTCare intervention. RESULTS: Costs not directly associated with delivery of the intervention were similar in the 2 arms: $9121 and $9222 for the APTCare and control arms, respectively. Costs directly associated with the program were $3802 per patient for a total cost per patient of $12,923 and $9222, respectively (P=.033). A 1% improvement in QOC was estimated to cost $407 per patient. Analysis of the net benefit to society in absolute dollars found a breakeven threshold of $750 when statistical significance was required. This implies that society must place a value of at least $750 on a 1% improvement in QOC in order for the intervention to be socially worthwhile. By any of the metrics used, the APTCare intervention was not cost-effective, at least not in a population for which baseline QOC was high. CONCLUSION: Although our calculations suggest that the APTCare intervention was not cost-effective, our results need the following caveats. The costs of such a newly introduced intervention are bound to be higher than those for an established, up-and-running program. Furthermore, it is possible that some benefits of the secondary preventive measures were not captured in this limited 12- to 18-month study or were simply not measured. TRIAL REGISTRATION NUMBER NCT00238836 (CONSORT).
Authors: S L Hughes; F M Weaver; A Giobbie-Hurder; L Manheim; W Henderson; J D Kubal; A Ulasevich; J Cummings Journal: JAMA Date: 2000-12-13 Impact factor: 56.272
Authors: Jeff E Borenstein; Geneen Graber; Emmanuel Saltiel; Joel Wallace; Seonyoung Ryu; Jackson Archi; Stephen Deutsch; Scott R Weingarten Journal: Pharmacotherapy Date: 2003-02 Impact factor: 4.705
Authors: David Litaker; Lorraine Mion; Loretta Planavsky; Christopher Kippes; Neil Mehta; Joseph Frolkis Journal: J Interprof Care Date: 2003-08 Impact factor: 2.338
Authors: Paul McCrone; Martin Knapp; Judith Proudfoot; Clash Ryden; Kate Cavanagh; David A Shapiro; Sophie Ilson; Jeffrey A Gray; David Goldberg; Anthony Mann; Isaac Marks; Brian Everitt; Andre Tylee Journal: Br J Psychiatry Date: 2004-07 Impact factor: 9.319
Authors: Susan Baxter; Maxine Johnson; Duncan Chambers; Anthea Sutton; Elizabeth Goyder; Andrew Booth Journal: BMC Health Serv Res Date: 2018-05-10 Impact factor: 2.655