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Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial

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Original languageEnglish
Article numbere030110
Number of pages10
JournalBMJ Open
Issue number1
DateAccepted/In press - 18 Nov 2019
DatePublished (current) - 19 Jan 2020


Objective Patients with multiple chronic health conditions are often managed in a disjointed fashion in primary care, with annual review clinic appointments offered separately for each condition. This study aimed to determine the cost-effectiveness of the 3D intervention, which was developed to improve the system of care.

Economic evaluation conducted alongside a pragmatic cluster-randomised trial.

General practices in three centres in England and Scotland.

797 adults with three or more chronic conditions were randomised to the 3D intervention, while 749 participants were randomised to receive usual care.

The 3D approach: comprehensive 6-monthly general practitioner consultations, supported by medication reviews and nurse appointments.

Primary and secondary outcome measures
The primary economic evaluation assessed the cost per quality-adjusted life year (QALY) gained from the perspective of the National Health Service (NHS) and personal social services (PSS). Costs were related to changes in a range of secondary outcomes (QALYs accrued by both participants and carers, and deaths) in a cost–consequences analysis from the perspectives of the NHS/PSS, patients/carers and productivity losses.

Very small increases were found in both QALYs (adjusted mean difference 0.007 (−0.009 to 0.023)) and costs (adjusted mean difference £126 (£−739 to £991)) in the intervention arm compared with usual care after 15 months. The incremental cost-effectiveness ratio was £18 499, with a 50.8% chance of being cost-effective at a willingness-to-pay threshold of £20 000 per QALY (55.8% at £30 000 per QALY).

The small differences in costs and outcomes were consistent with chance, and the uncertainty was substantial; therefore, the evidence for the cost-effectiveness of the 3D approach from the NHS/PSS perspective should be considered equivocal.

    Structured keywords

  • BRTC
  • Bristol Population Health Science Institute

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