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Cost-effectiveness analysis of health tapestry, a complex primary care program for older adults: a post-hoc analysis.
- Source :
- BMC Primary Care; 7/3/2024, Vol. 25 Issue 1, p1-10, 10p
- Publication Year :
- 2024
-
Abstract
- Background: We initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site. Methods: Costs included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars. Results: With an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI. Conclusion: Health TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site. [ABSTRACT FROM AUTHOR]
- Subjects :
- MEDICAL care use
FAMILY health
QUALITY-adjusted life years
HUMAN services programs
COST effectiveness
DATA analysis
INCOME
T-test (Statistics)
RESEARCH funding
PRIMARY health care
MEDICAL care
QUESTIONNAIRES
HOSPITAL care
MULTIVARIATE analysis
DECISION making
COST benefit analysis
DESCRIPTIVE statistics
CHI-squared test
STATISTICS
RESEARCH
QUALITY of life
MEDICAL care for older people
HEALTH outcome assessment
COMPARATIVE studies
CONFIDENCE intervals
MEDICAL care costs
NONPARAMETRIC statistics
ECONOMICS
OLD age
Subjects
Details
- Language :
- English
- ISSN :
- 27314553
- Volume :
- 25
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- BMC Primary Care
- Publication Type :
- Academic Journal
- Accession number :
- 178276570
- Full Text :
- https://doi.org/10.1186/s12875-024-02475-5