Cost-effectiveness analysis for a tele-based health coaching program for chronic disease in primary care

Abstract

BackgroundThe burden of chronic disease and multimorbidity is rapidly increasing. Self-management support interventions are effective in reduce cost, especially when targeted at a single disease group; however, economical evidence of such complex interventions remains scarce. The objective of this study was to evaluate a cost-effectiveness analysis of a tele-based health-coaching intervention among patients with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF).MethodsA total of 1570 patients were blindly randomized to intervention (n = 970) and control (n = 470) groups. The intervention group received monthly individual health coaching by telephone from a specially trained nurse for 12-months in addition to routine social and healthcare. Patients in the control group received routine social and health care. Quality of life was assessed at the beginning of the intervention and follow-up measurements were made after 12 months health coaching. The cost included all direct health-care costs supplemented with home care and nursing home-care costs in social care. Utility was based on a Health Related Quality of Life (HRQoL) measurement (15D instrument), and cost effectiveness was assessed using incremental cost-effectiveness ratios (ICERs).ResultsThe cost-effectiveness of health coaching was highest in the T2D group (ICER €20,000 per Quality-Adjusted Life Years [QALY]). The ICER for the CAD group was more modest (€40,278 per QALY), and in the CHF group, costs increased with no marked effect on QoL. Probabilistic sensitivity analysis indicated that at the societal willingness to pay threshold of €50,000 per QALY, the probability of health coaching being cost effective was 55% in the whole study group.ConclusionsThe cost effectiveness of health coaching may vary substantially across patient groups, and thus interventions should be targeted at selected subgroups of chronically ill. Based on the results of this study, health coaching improved the QoL of T2D and CAD patients with moderate costs. However, the results are grounded on a short follow-up period, and more evidence is needed to evaluate the long-term outcomes of health-coaching programs.Trial registration NCT00552903 [Prospectively registered, registration date 1st November 2007, last updated 3rd February 2009].

Compendium of Health and Wellness Coaching: 2019 Addendum

“…Notably, a study of HWC costeffectiveness found the best return on investment when treating diabetic patients, with cardiac patients also treated with an acceptably moderate cost. 17 In agreement with our summary from the original HWC Compendium, the Addendum shows outcome results consistent with HWC as a potentially valuable intervention for diabetic care. After coaching intervention, there was a near unanimous finding of improved A1C, the primary research and care variable for diabetes management.…”

“…A preliminary example of this sort of research examined cost-effectiveness of HWC intervention in a large group of patients. 17 In this study, HWC had greater impact on quality-adjusted life years in diabetic and coronary artery disease patients than in other patient presentations across a sample of 970 participants. Although this is a single study on an isolated outcome, greater emphasis on comparative effectiveness analysis of the HWC intervention is needed; such study will ultimately define scope of practice for HWC professionals.…”

Health coaching for healthcare employees with chronic disease: A pilot study

“…Employees with chronic, multiple chronic and/or complex disease(s) account for a large percentage of these costs [9,10], and cost-effectiveness and work productivity research is needed. Although a discussion of healthcare costs is beyond the scope of this health coaching pilot, one such study found that health coaching for chronic diseases such as type II diabetes and coronary artery disease were cost effective, while it was not cost effective for the management of congestive heart failure (CHF) [28]. This suggests that health coaching cost effectiveness may vary across subgroups of chronically ill clients or patients.…”

Coaching as a method for potentially reducing the risk of burnout in medical professionals

“…Coaching can be successfully taken advantage of by the health sciences [59,60] and medical sciences [inter alia: 27,61,62], to name only a few. Health coaching frequently appears in the context of research on a group of chronically ill patients [inter alia: [63][64][65][66]. Its efficacy has also been confirmed in relation to elderly people [67].…”