Home and Community Care Digest

Home and Community Care Digest 5(4) December 2006 : 0-0

Self-managed care of inflammatory bowel disease: Same outcomes but at a lower cost

Abstract

Self-managed care may be a viable means of treating illnesses, especially chronic conditions like inflammatory bowel disease. The purpose of this study was to compare the cost-effectiveness of a selfmanaged care approach with regular practice (i.e., fixed appointment scheme) for patients with inflammatory bowel disease (IBD) using a "system" perspective. The self-managed care intervention consisted of providing patients with an evidence-based self-help guidebook, patient-centred consultations, and a direct access service allowing patients to self-refer when they felt necessary. Selfmanaged care seems to deliver similar outcomes as regular care patients, but at a lower cost. This lower cost was the result of fewer outpatient visits by self-managed care patients, decreasing costs by 14%.
Background: Self-managed care may be a viable means of treating illnesses, especially chronic conditions. By providing patients with information on their condition(s) and allowing them to self-refer to specialists when the patient deems necessary, patients' quality of life may improve while using health care resources more efficiently. The purpose of this study was to compare the cost-effectiveness of a self-managed care approach with regular practice (i.e., fixed appointment scheme) for patients with inflammatory bowel disease (IBD) using a "system" perspective.

Methods: The self-managed care intervention consisted of providing patients with an evidence-based self-help guidebook, patient-centred consultations, and a direct access service allowing patients to selfrefer when they felt necessary. The authors used data collected from a study in the United Kingdom (UK) over a one year period to conduct a cost-effectiveness analysis. Data on resource use were comprised of general physician visits, days of inpatient stay, outpatient appointments, medication, and intervention costs. Data sources included entry/exit interviews, patient diaries, and hospital medical records. Health outcomes were assessed in terms of quality-adjusted life years (QALY).

Findings: On average, patients in both the regular practice and self-care groups were slightly worse after one year with no meaningful differences between the groups. However, the self-care group used the system less than the regular practice group. In particular, the regular practice group had 60% more IBDrelated outpatient visits than the self-care group over the same 12-month period. The total average cost to treat a patient in the regular practice was P1,070 versus P922 for the self-care group (a difference of P148 per patient or 14%). The incremental cost was P676,417 for each additional QALY for regular practice compared with self-managed care. The cost of the self-managed care program was estimated at P9 per patient per year based on the cost of the specialist and nurse time.

Conclusions: Self-managed care does not seem to have a negative impact on patients' health compared with regular practice when treating inflammatory bowel disease. Self-managed care made little difference to patients' health when compared with regular practice, but reduced health service costs (i.e., same health outcomes for less cost) by decreasing overall system use.

Reference: Richardson G, Sculpher M, Kennedy A, Nelson E, Reeves D, Roberts C, Robinson A, Rogers A, Thompson D. "Is self-care a cost-effective use of resources? Evidence from a randomized trial in inflammatory bowel disease." Journal of Health Services Research Policy, 2006; 11, 225-230.

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