IDEAS home Printed from https://ideas.repec.org/a/spr/hecrev/v9y2019i1d10.1186_s13561-019-0221-2.html
   My bibliography  Save this article

Cost-effectiveness analysis of case management for optimized antithrombotic treatment in German general practices compared to usual care – results from the PICANT trial

Author

Listed:
  • Lisa R. Ulrich

    (Goethe-University Frankfurt am Main)

  • Juliana J. Petersen

    (Goethe-University Frankfurt am Main)

  • Karola Mergenthal

    (Goethe-University Frankfurt am Main)

  • Andrea Berghold

    (Statistics and Documentation, Medical University of Graz)

  • Gudrun Pregartner

    (Statistics and Documentation, Medical University of Graz)

  • Rolf Holle

    (Institute of Health Economics and Health Care Management
    German Center for Diabetes Research)

  • Andrea Siebenhofer

    (Goethe-University Frankfurt am Main
    Medical University of Graz)

Abstract

Background By performing case management, general practitioners and health care assistants can provide additional benefits to their chronically ill patients. However, the economic effects of such case management interventions often remain unclear although how to manage the burden of chronic disease is a key question for policy-makers. This analysis aimed to compare the cost-effectiveness of 24 months of primary care case management for patients with a long-term indication for oral anticoagulation therapy with usual care. Methods This analysis is part of the cluster-randomized controlled Primary Care Management for Optimized Antithrombotic Treatment (PICANT) trial. A sample of 680 patients with German statutory health insurance was initially considered for the cost analysis (92% of all participants at baseline). Costs included all disease-related direct health care costs from the payer’s perspective (German statutory health insurers) plus case management costs for the intervention group. A-Quality Adjusted Life Year (QALY) measurement (EQ-5D-3 L instrument) was used to evaluate utility, and incremental cost-effectiveness ratio (ICER) to assess cost-effectiveness. Mean differences were calculated and displayed with 95%-confidence intervals (CI) from non-parametric bootstrapping (1000 replicates). Results N = 505 patients (505/680, 74%) were included in the cost analysis (complete case analysis with a follow-up after 12 and 24 months as well as information on cost and QALY). After two years, the mean difference of direct health care costs per patient (€115, 95% CI [− 201; 406]) and QALYs (0.03, 95% CI [− 0.04; 0.11]) in the two groups was small and not significant. The costs of case management in the intervention group caused mean total costs per patient in this group to rise significantly (mean difference €503, 95% CI [188; 794]). The ICER was €16,767 per QALY. Regardless of the willingness of insurers to pay per QALY, the probability of the intervention being cost-effective never rose above 70%. Conclusions A primary care case management for patients with a long-term indication for oral anticoagulation therapy improved QALYs compared to usual care, but was more costly. However, the results may help professionals and policy-makers allocate scarce health care resources in such a way that the overall quality of care is improved at moderate costs, particularly for chronically ill patients. Trial registration Current Controlled Trials ISRCTN41847489 .

Suggested Citation

  • Lisa R. Ulrich & Juliana J. Petersen & Karola Mergenthal & Andrea Berghold & Gudrun Pregartner & Rolf Holle & Andrea Siebenhofer, 2019. "Cost-effectiveness analysis of case management for optimized antithrombotic treatment in German general practices compared to usual care – results from the PICANT trial," Health Economics Review, Springer, vol. 9(1), pages 1-10, December.
    • Handle: RePEc:spr:hecrev:v:9:y:2019:i:1:d:10.1186_s13561-019-0221-2
    DOI: 10.1186/s13561-019-0221-2
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s13561-019-0221-2
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1186/s13561-019-0221-2?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    2. Brazier, John & Roberts, Jennifer & Deverill, Mark, 2002. "The estimation of a preference-based measure of health from the SF-36," Journal of Health Economics, Elsevier, vol. 21(2), pages 271-292, March.
    3. Walters, SJ & Brazier, JE, 2002. "Sample sizes for the SF-6D preference based measure of health from the SF-36: a practical guide," MPRA Paper 29742, University Library of Munich, Germany.
    4. G Torrance & Y Zhang & D Feeny & W Furlong & R Barr, 1992. "Multi-attribute Utility Functions for a Comprehensive Health Status Classification System: Health Utilities Index Mark 2," Centre for Health Economics and Policy Analysis Working Paper Series 1992-18, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Rowen, D & Brazier, J & Tsuchiya, A & Hernández, M & Ibbotson, R, 2009. "The simultaneous valuation of states from multiple instruments using ranking and VAS data: methods and preliminary results," MPRA Paper 29841, University Library of Munich, Germany.
    2. O'Hagan, A & Brazier, JE & Kharroubi, SA, 2007. "A comparison of United States and United Kingdom EQ-5D health states valuations using a nonparametric Bayesian method," MPRA Paper 29806, University Library of Munich, Germany.
    3. Lisa Prosser & James Hammitt & Ron Keren, 2007. "Measuring Health Preferences for Use in Cost-Utility and Cost-Benefit Analyses of Interventions in Children," PharmacoEconomics, Springer, vol. 25(9), pages 713-726, September.
    4. Samer Kharroubi, 2015. "A Comparison of Japan and UK SF-6D Health-State Valuations Using a Non-Parametric Bayesian Method," Applied Health Economics and Health Policy, Springer, vol. 13(4), pages 409-420, August.
    5. Anirban Basu & William Dale & Arthur Elstein & David Meltzer, 2009. "A linear index for predicting joint health‐states utilities from single health‐states utilities," Health Economics, John Wiley & Sons, Ltd., vol. 18(4), pages 403-419, April.
    6. McCabe, Christopher & Brazier, John & Gilks, Peter & Tsuchiya, Aki & Roberts, Jennifer & O'Hagan, Anthony & Stevens, Katherine, 2006. "Using rank data to estimate health state utility models," Journal of Health Economics, Elsevier, vol. 25(3), pages 418-431, May.
    7. Makai, Peter & Brouwer, Werner B.F. & Koopmanschap, Marc A. & Stolk, Elly A. & Nieboer, Anna P., 2014. "Quality of life instruments for economic evaluations in health and social care for older people: A systematic review," Social Science & Medicine, Elsevier, vol. 102(C), pages 83-93.
    8. Stevens, K, 2010. "Valuation of the Child Health Utility Index 9D (CHU9D)," MPRA Paper 29938, University Library of Munich, Germany.
    9. Christopher McCabe & Katherine Stevens & Jennifer Roberts & John Brazier, 2005. "Health state values for the HUI 2 descriptive system: results from a UK survey," Health Economics, John Wiley & Sons, Ltd., vol. 14(3), pages 231-244, March.
    10. Ian M. McCarthy, 2015. "Putting the Patient in Patient Reported Outcomes: A Robust Methodology for Health Outcomes Assessment," Health Economics, John Wiley & Sons, Ltd., vol. 24(12), pages 1588-1603, December.
    11. Roisin Adams & Cathal Walsh & Douglas Veale & Barry Bresnihan & Oliver FitzGerald & Michael Barry, 2010. "Understanding the Relationship between the EQ-5D, SF-6D, HAQ and Disease Activity in Inflammatory Arthritis," PharmacoEconomics, Springer, vol. 28(6), pages 477-487, June.
    12. Feng Xie & A. Pickard & Paul Krabbe & Dennis Revicki & Rosalie Viney & Nancy Devlin & David Feeny, 2015. "A Checklist for Reporting Valuation Studies of Multi-Attribute Utility-Based Instruments (CREATE)," PharmacoEconomics, Springer, vol. 33(8), pages 867-877, August.
    13. Sun Sun & Nan Luo & Erik Stenberg & Lars Lindholm & Klas-Göran Sahlén & Karl A. Franklin & Yang Cao, 2022. "Sequential Multiple Imputation for Real-World Health-Related Quality of Life Missing Data after Bariatric Surgery," IJERPH, MDPI, vol. 19(17), pages 1-16, August.
    14. Ifigeneia Mavranezouli, 2010. "A Review and Critique of Studies Reporting Utility Values for Schizophrenia-Related Health States," PharmacoEconomics, Springer, vol. 28(12), pages 1109-1121, December.
    15. David Feeny, 2012. "The Multi-attribute Utility Approach to Assessing Health-related Quality of Life," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 36, Edward Elgar Publishing.
    16. Samer A. Kharroubi & Yara Beyh, 2021. "Bayesian modeling of health state preferences: could borrowing strength from existing countries’ valuations produce better estimates," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(5), pages 773-788, July.
    17. Jeff Richardson & Angelo Iezzi & Aimee Maxwell, 2017. "How important is severity for the evaluation of health services: new evidence using the relative social willingness to pay instrument," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(6), pages 671-683, July.
    18. Katherine Stevens, 2012. "Valuation of the Child Health Utility 9D Index," PharmacoEconomics, Springer, vol. 30(8), pages 729-747, August.
    19. Michela Tinelli & Mandy Ryan & Christine Bond & Anthony Scott, 2013. "Valuing Benefits to Inform a Clinical Trial in Pharmacy," PharmacoEconomics, Springer, vol. 31(2), pages 163-171, February.
    20. L. M. Lamers & J. McDonnell & P. F. M. Stalmeier & P. F. M. Krabbe & J. J. V. Busschbach, 2006. "The Dutch tariff: results and arguments for an effective design for national EQ‐5D valuation studies," Health Economics, John Wiley & Sons, Ltd., vol. 15(10), pages 1121-1132, October.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:hecrev:v:9:y:2019:i:1:d:10.1186_s13561-019-0221-2. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com/economics/journal/13561 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.