Cost-Effectiveness of the Wellness Incentives and Navigation (WIN) Program
| Autor: | Keith E. Muller, Dena Stoner, Walter Bruce Vogel, Heather L. Morris, Tianyao Huo, Alice Parish, Elizabeth Shenkman |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Gerontology Health Knowledge Attitudes Practice Cost effectiveness Cost-Benefit Analysis Health Status Population Motivational interviewing Health Promotion Motivational Interviewing Young Adult 03 medical and health sciences 0302 clinical medicine Intervention (counseling) Humans Patient Navigation Medicine Longitudinal Studies Multiple Chronic Conditions 030212 general & internal medicine education health care economics and organizations education.field_of_study Medicaid managed care Medicaid business.industry 030503 health policy & services Health Policy Public Health Environmental and Occupational Health Texas Mental health Self Concept United States Self Care Socioeconomic Factors Economic evaluation Female Quality-Adjusted Life Years 0305 other medical science business |
| Zdroj: | Value in Health. 24:361-368 |
| ISSN: | 1098-3015 |
| DOI: | 10.1016/j.jval.2020.06.019 |
| Popis: | Objectives Promoting patient involvement in managing co-occurring physical and mental health conditions is increasingly recognized as critical to improving outcomes and controlling costs in this growing chronically ill population. The main objective of this study was to conduct an economic evaluation of the Wellness Incentives and Navigation (WIN) intervention as part of a longitudinal randomized pragmatic clinical trial for chronically ill Texas Medicaid enrollees with co-occurring physical and mental health conditions. Methods The WIN intervention used a personal navigator, motivational interviewing, and a flexible wellness expense account to increase patient activation, that is, the patient’s knowledge, skills, and confidence in managing their self-care and co-occurring physical and mental health conditions. Regression models were fit to both participant-level quality-adjusted life years (QALYs) and total costs of care (including the intervention) controlling for demographics, health status, poverty, Medicaid managed care plan, intervention group, and baseline health utility and costs. Incremental costs and QALYs were calculated based on the difference in predicted costs and QALYs under intervention versus usual care and were used to calculate the incremental cost-effectiveness ratios (ICERs). Confidence intervals were calculated using Fieller’s method, and sensitivity analyses were performed. Results The mean ICER for the intervention compared with usual care was $12 511 (95% CI $8971-$16 842), with a sizable majority of participants (70%) having ICERs below $40 000. The WIN intervention also produced higher QALY increases for participants who were sicker at baseline compared to those who were healthier at baseline. Conclusion The WIN intervention shows considerable promise as a cost-effective intervention in this challenging chronically ill population. |
| Databáze: | OpenAIRE |
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