Is self-care a cost-effective use of resources? Evidence from a randomized trial in inflammatory bowel disease.
OBJECTIVE
To determine if a whole-system approach to self-management in inflammatory bowel disease (IBD), using a guidebook developed with patients and physicians trained in patient-centred care, leads to cost-effective use of health system resources.


METHODS
Cost-effectiveness analysis over a one-year time horizon comparing the whole systems self-management approach to treatment with usual treatment. Nineteen hospitals in the northwest England were randomized to the intervention or to be controls; 651 patients (285 at intervention sites and 366 at control sites) with established IBD were included. The economic evaluation related differential health service costs, from a UK NHS perspective, to differences in quality-adjusted life years (QALYs) based on patients' responses to the EQ-5D.


RESULTS
The intervention was associated with a mean reduction in costs of 148 pounds sterling per patient and a small mean reduction in QALYs of 0.00022 per patient compared with the control group. This resulted in an incremental cost per QALY gained of 676,417 pounds sterling for treatment as usual and a probability of around 63% that the whole-system approach to self-management is cost-effective, assuming a willingness to pay up to 30,000 pounds sterling for an additional QALY.


CONCLUSIONS
Although there is uncertainty associated with these estimates, more widespread use of this method in chronic disease management seems likely to reduce health care costs without evidence of adverse effect on patient outcomes.
Richardson
Gerald
G
Centre for Health Economics, University of York, UK. gar2@york.ac.uk
Sculpher
Mark
M
Kennedy
Anne
A
Nelson
Elizabeth
E
Reeves
David
D
Roberts
Chris
C
Robinson
Andrew
A
Rogers
Anne
A
Thompson
David
D
D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D017598:Efficiency, Organizational; D004739:England; D019317:Evidence-Based Medicine; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics*; D013222:State Medicine