Modelling the cost-effectiveness of person-centred care for patients with acute coronary syndrome

Abstract

Background Person-centred care has been shown to be cost-effective compared to usual care for several diseases, including acute coronary syndrome, in a short-term time perspective (< 2 years). The cost-effectiveness of person-centred care in a longer time perspective is largely unknown. Objectives To estimate the mid-term cost-effectiveness of person-centred care compared to usual care for patients (< 65) with acute coronary syndrome, using a 2-year and a 5-year time perspective. Methods The mid-term cost-effectiveness of person-centred care compared to usual care was estimated by projecting the outcomes observed in a randomized-controlled trial together with data from health registers and data from the scientific literature, 3 years beyond the 2-year follow-up, using the developed simulation model. Probabilistic sensitivity analyses were performed using Monte Carlo simulation. Results Person-centred care entails lower costs and improved effectiveness as compared to usual care, for a 2-year time and a 5-year perspective. Monte Carlo simulations suggest that the likelihoods of the person-centred care being cost-effective compared to usual care were between 80 and 99% and between 75 and 90% for a 2-year and a 5-year time perspective (using a 500,000 SEK/QALY willingness-to-pay threshold). Conclusions Person-centred care was less costly and more effective compared to usual care in a 2-year and a 5-year time perspective for patients with acute coronary syndrome under the age of 65.

The JECP‐European Society for Person‐Centered Healthcare (ESPCH) Section on Person‐Centred Care

“…6 Recent years, however, have seen a growing emphasis on notions of value deriving from the pursuit of 'best practice'. 6,[24][25][26] Given the mid and especially postpandemic ravages of the SARS-CoV-2 pandemic on health systems, which brought many institutional health services to the brink of essential collapse, 27 it is more than premature at the time of writing to expect governments, politicians, healthcare policymakers, and clinical service managers, to move away from a currently resolute focus on the demand-led, supply-driven basis of healthcare provision, toward the person-centred ideal. Yet the direction of travel, as it were, is away from a solitary focus on the volume of service delivery toward a greater and preferential emphasis on superior patient outcomes, which is to say 'value', in addition.…”

“…28,29 On the basis of current and accumulating evidence, it is becoming rapidly clear that PCC has the potential to mediate significant changes within a variety of important indices of patient behaviour and healthcare service utilization that are directly 'resource-impacting', most of which are associated with an increased quality of care at reduced or contained cost. 6,[24][25][26] For this reason, we urgently need far more intensive health economic evaluations of 'PCC in action', and it is clear from the literature that such studies are increasing in frequency and impact.…”

“…Until very recently in HSR, politicians and policymakers defined cost‐effectiveness and service efficiency in healthcare solely in terms of cost‐reduction and cost containment 6 . Recent years, however, have seen a growing emphasis on notions of value deriving from the pursuit of ‘best practice’ 6,24–26 …”

“…Within, perhaps, a relatively short timeframe, we can therefore expect politicians, policymakers, health services managers and clinicians themselves, to pay much greater attention to the increasing corpus of relevant PCC economic data at their disposal. This, we predict, can only support a deepening implementation of PCC, so that this ‘new way of thinking and doing in clinical practice’ can become an imbedded operational, and indeed fully cost‐effective, reality 6,24–26 …”

Commentary: how person-centred is pharmaceutical care?

“…A similar challenge remains in insufficient knowledge available on how different members of professional teams will collaborate to provide their end of the partnership; pharmacists are not expected to be the sole carer of a patient, and thus are always part of a larger team with the patient and other HCPs. Whilst PCC has often resulted in beneficial [5,27,32], even cost-effective [33][34][35][36], results in randomised controlled trials, there are costs associated with implementation, including increased time spent in initiating the partnership. Thus, many questions remain as to how pharmaceutical care can become more person-centred, such as financial aspects and the acceptance of the changing role among pharmacists, other HCPs, and not least, amongst patients.…”