An Electronic Patient-Reported Outcomes Tool for Older Adults With Complex Chronic Conditions: Cost-Utility Analysis

Abstract

Background: eHealth technologies for self-management can improve quality of life, but little is known about whether the benefits gained outweigh their costs. The electronic patient-reported outcome (ePRO) mobile app and portal system supports patients with multiple chronic conditions to collaborate with primary health care providers to set and monitor health-related goals.

Objective: This study aims to estimate the cost of ePRO and the cost utility of the ePRO intervention compared with usual care provided to patients with multiple chronic conditions and complex needs living in the community, from the perspective of the publicly funded health care payer in Ontario, Canada.

Methods: We developed a decision tree model to estimate the incremental cost per quality-adjusted life year (QALY) gained for the ePRO tool versus usual care over a time horizon of 15 months. Resource utilization and effectiveness of the ePRO tool were drawn from a randomized clinical trial with 6 family health teams involving 45 participants. Unit costs associated with health care utilization (adjusted to 2020 Canadian dollars) were drawn from literature and publicly available sources. A series of sensitivity analyses were conducted to assess the robustness of the findings.

Results: The total cost of the ePRO tool was CAD $79,467 (~US $ 63,581; CAD $1733 [~US $1386] per person). Compared with standard care, the ePRO intervention was associated with higher costs (CAD $1710 [~US $1368]) and fewer QALYs (-0.03). The findings were consistent with the clinical evidence, suggesting no statistical difference in health-related quality of life between ePRO and usual care groups. However, the tool would be considered a cost-effective option if it could improve by at least 0.03 QALYs. The probability that the ePRO is cost-effective was 17.3% at a willingness-to-pay (WTP) threshold of CAD $50,000 (~US $40,000)/QALY.

Conclusions: The ePRO tool is not a cost-effective technology at the commonly used WTP value of CAD $50,000 (~US $40,000)/QALY, but long-term and the societal impacts of ePRO were not included in this analysis. Further research is needed to better understand its impact on long-term outcomes and in real-world settings. The present findings add to the growing evidence about eHealth interventions' capacity to respond to complex aging populations within finite-resourced health systems.

Trial registration: ClinicalTrials.gov NCT02917954; https://ichgcp.net/clinical-trials-registry/NCT02917954.

Keywords: Canada; North America; aging; chronic condition; chronic disease; community; complex care; cost; cost-effectiveness; decision tree; eHealth; elder; model; multimorbidity; older adult; patient reported outcome; primary care; sensitivity analysis.

Conflict of interest statement

Conflicts of Interest: Funding for this study is through a Canadian Federal Grant (CIHR; FN-143559), with the salaries of authors RHH, BCFC, CSG, WPW, and KT being funded through their academic and scientific positions at their respective institutions.

©Rafael N Miranda, Aunima R Bhuiya, Zak Thraya, Rebecca Hancock-Howard, Brian CF Chan, Carolyn Steele Gray, Walter P Wodchis, Kednapa Thavorn. Originally published in JMIR Aging (https://aging.jmir.org), 20.04.2022.

Figures

Figure 1

One-way sensitivity analysis (tornado diagram). ePRO: electronic patient-reported outcome; EV: expected value; IT: information technology; NMB: net monetary benefit; QALY: quality-adjusted life year;.

Figure 2

Probabilistic sensitivity analysis. WTP: willingness-to-pay threshold.

Figure 3

Cost-effectiveness acceptability curve. ePRO: electronic patient-reported outcome.