Cost-Utility Analysis of The Electronic Patient Reported Outcomes Tool for Older Adults with Complex Chronic Conditions
ABSTRACT
Background:
Electronic health (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 application and portal system supports older adults with multiple chronic conditions to collaborate with primary health care providers to set and monitor health-related goals.
Objective:
To estimate the cost of ePRO and the cost-utility of the ePRO intervention compared to usual care provided to older adults 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 (RCT) 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 $79,467 ($1,733 per person). Compared to standard care, the ePRO intervention was associated with higher costs ($1,710) 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 at by least 0.03 QALY. The probability that the ePRO is cost-effective was 17.3% at a willingness-to-pay (WTP) threshold of $50,000/QALY.
Conclusions:
The ePRO tool is not a cost-effective technology at the commonly used WTP value of $50,000/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. Clinical Trial: ClinicalTrials.gov NCT02917954
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