TY  - JOUR
AU  - Miranda, Rafael N
AU  - Bhuiya, Aunima R
AU  - Thraya, Zak
AU  - Hancock-Howard, Rebecca
AU  - Chan, Brian CF
AU  - Steele Gray, Carolyn
AU  - Wodchis, Walter P
AU  - Thavorn, Kednapa
PY  - 2022
DA  - 2022/4/20
TI  - An Electronic Patient-Reported Outcomes Tool for Older Adults With Complex Chronic Conditions: Cost-Utility Analysis
JO  - JMIR Aging
SP  - e35075
VL  - 5
IS  - 2
KW  - eHealth
KW  - multimorbidity
KW  - primary care
KW  - cost-effectiveness
KW  - older adult
KW  - elder
KW  - cost
KW  - patient reported outcome
KW  - community
KW  - complex care
KW  - aging
KW  - Canada
KW  - North America
KW  - chronic disease
KW  - chronic condition
KW  - decision tree
KW  - model
KW  - sensitivity analysis
AB  - Background: 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 app and portal system supports patients with multiple chronic conditions to collaborate with primary health care providers to set and monitor health-related goals. Objective: This study aims to estimate the cost of ePRO and the cost utility of the ePRO intervention compared with usual care provided to patients 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 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 CAD $79,467 (~US $ 63,581; CAD $1733 [~US $1386] per person). Compared with standard care, the ePRO intervention was associated with higher costs (CAD $1710 [~US $1368]) 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 by at least 0.03 QALYs. The probability that the ePRO is cost-effective was 17.3% at a willingness-to-pay (WTP) threshold of CAD $50,000 (~US $40,000)/QALY. Conclusions: The ePRO tool is not a cost-effective technology at the commonly used WTP value of CAD $50,000 (~US $40,000)/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. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 
SN  - 2561-7605
UR  - https://aging.jmir.org/2022/2/e35075
UR  - https://doi.org/10.2196/35075
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35442194
DO  - 10.2196/35075
ID  - info:doi/10.2196/35075
ER  -