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Purpose For an integrated care programme to be successful, preferences of the stakeholders involved should be aligned. The aim of this study is to investigate to which extent outcomes beyond health are valued and to study the heterogeneity of preferences of those involved in integrated care. Methods A discrete choice experiment (DCE) was conducted to elicit preferences for eight Triple Aim outcomes, i.e., physical functioning, psychological well-being, social relationships & participation, enjoyment of life, resilience, person-centeredness, continuity of care and total health and social care costs. Stakeholders were recruited among Dutch persons with multi-morbidity, informal caregivers, professionals, payers, and policymakers. A Bayesian mixed-logit model was used to analyse the data. Subsequently, a latent class analysis was performed to identify stakeholders with similar preferences. Results 739 stakeholders completed the DCE. Enjoyment of life was perceived as the most important outcome (relative importance: 0.221) across stakeholders, while total health and social care costs were perceived as least important (0.063). The latent class analysis identified four classes. The first class (19.9%) put most weight on experience with care outcomes. The second class (39%) favoured enjoyment of life. The third class (18%) focused relatively more on physical health. The fourth class (24%) had the least consistent preferences. Conclusion This study has highlighted the heterogeneity in views of stakeholders in integrated care on what is important in health(care) for persons with multi-morbidity. To accurately value integrated care a variety of outcomes beyond health–e.g., enjoyment of life and experience with care–should be taken into account.

Objective The objective of this study was to develop guidance contributing to improved consistency and quality in economic evaluations of personalised medicine (PM), given current ambiguity about how to measure the value of PM as well as considerable variation in the methodology and reporting in economic evaluations of PM. Methods A targeted literature review of methodological papers was performed for an overview of modelling challenges in PM. Expert interviews were held to discuss best modelling practice. A systematic literature review of economic evaluations of PM was conducted to gain insight into current modelling practice. The findings were synthesised and used to develop a set of draft recommendations. The draft recommendations were discussed at a stakeholder workshop and subsequently finalised. Results Twenty-two methodological papers were identified. Some argued that the challenges in modelling PM can be addressed within existing methodological frameworks, others disagreed. Eighteen experts were interviewed. They believed large uncertainty to be a key concern. Out of 195 economic evaluations of PM identified, 56% addressed none of the identified modelling challenges. A set of 23 recommendations was developed. Eight recommendations focus on the modelling of test-treatment pathways. The use of non-randomised controlled trial data is discouraged but several recommendations are provided in case randomised controlled trial data are unavailable. The parameterisation of structural uncertainty is recommended. Other recommendations consider perspective and discounting; premature survival data; additional value elements; patient and clinician compliance; and managed entry agreements. Conclusions This study provides a comprehensive list of recommendations to modellers of PM and to evaluators and reviewers of PM models. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-021-01010-z.

Doel Beoordelen van het effect van de ‘Ziektelastmeter COPD’ op de ziektespecifieke kwaliteit van leven bij patiënten met COPD. Opzet Clustergerandomiseerde gecontroleerde trial. Methode Dit betrof een onderzoek in 39 Nederlandse huisartsenpraktijken en 17 ziekenhuizen bij 357 patiënten met COPD (postbronchodilatoire FEV1/FVC-ratio: < 0,7) van 40 jaar of ouder. We randomiseerden zorgverleners tussen een interventie- en controlegroep, waarbij patiënten uit de interventiegroep behandeld werden met behulp van de ‘Ziektelastmeter COPD’. Dit innovatieve instrument bestaat uit een korte gevalideerde vragenlijst en een aantal objectieve parameters, die samen de integrale gezondheidstoestand visueel weergeven en via een behandelalgoritme leiden tot een individueel zorgplan. Patiënten uit de controlegroep ontvingen de gebruikelijke zorg. De primaire uitkomstmaat was het aantal patiënten met een klinisch relevante verbetering in ziektespecifieke kwaliteit van leven gemeten met de ‘St. George’s respiratory questionnaire’ (SGRQ) na een follow-upduur van 18 maanden. Secundaire uitkomstmaten waren onder andere de SGRQ-totaalscore en de ‘Patient assessment of chronic illness care’(PACIC)-score. Resultaten Na 18 maanden was er een statistisch significant en klinisch relevante toename in de SGRQ-score bij 49 patiënten (34%) in de interventiegroep en bij 33 patiënten (22%) in de controlegroep (oddsratio: 1,85; 95%-BI: 1,08-3,16). Patiënten in de interventiegroep ervoeren een hogere kwaliteit van zorg dan die in de controlegroep (verschil in PACIC-score: 0,32; 95%-BI: 0,14-0,50). Conclusie Gebruik van de ‘Ziektelastmeter COPD’ resulteert in een hogere ziektespecifieke kwaliteit van leven en hogere kwaliteit van zorg voor COPD-patiënten. Dit instrument kan een veelbelovende bijdrage leveren aan de dagelijkse COPD-zorg. We adviseren deze studie te repliceren, zo mogelijk in de buitenlandse gezondheidszorg.