Cost-effectiveness of Anticipatory and Preventive multidisciplinary Team Care for complex patients: evidence from a randomized controlled trial

Abstract

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).

Figures

Figure 1.

Cost-effectiveness acceptability curve

Figure 2.

Estimated effect of the APTCare intervention on the net benefit to society in absolute dollars