Cost-utility analysis of an integrated care model for multimorbid patients based on a clinical trial

Abstract

Objective: To conduct a cost-utility analysis on an integrated healthcare model comprising an assigned internist and a hospital liaison nurse for patients with multimorbidity, compared to a conventional reactive healthcare system.

Methods: A cluster randomised clinical trial was conducted. The model consisted of a reference internist and a liaison nurse, who aimed to improve coordination and communication between levels and to enhance continuity of care after hospitalisation. We recorded sociodemographic data, diagnoses and corresponding clinical categories, functional status, use of healthcare resources and quality of life. Data were collected by reviewing electronic medical records and administering questionnaires. We performed univariate and multivariate analyses both for utilities and total costs. Bootstrapping methods were applied to calculate the confidence ellipses of incremental costs and efficiency.

Results: We recruited a total of 140 patients. The model assessed was not found to be efficient in general. We found an incremental cost of €1,035.90 and an incremental benefit of -0.0762 QALYs for the initiative compared to standard care after adjusting for the main variables. However, the subgroup of patients under 80 years of age with three or more clinical categories resulted in an 89% cost saving in the simulations.

Conclusions: The integrated model was not suitable for all study patients. However, the subgroup analysis identified a narrow target population that should be analysed in future studies.

Keywords: Análisis de coste-beneficio; Asistencia sanitaria integrada; Clinical trial; Comorbidity; Comorbilidad; Cost-benefit analysis; Ensayo clínico; Integrated healthcare.