The cost of a patient activation intervention for achieving successful outcomes: results from the PAADRN randomized controlled trial

Summary In a large, pragmatic clinical trial, we calculated the costs of achieving four successful patient-centered outcomes using a tailored patient activation DXA result letter accompanied by a bone health brochure. The cost to achieve one successful outcome (e.g., a 0.5 standard deviation improve...

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Bibliographic Details
Published in:	Osteoporosis international Vol. 28; no. 10; pp. 3061 - 3066
Main Authors:	Wolinsky, F. D., Hall, S. F., Lou, Y., Edmonds, S. W., Saag, K. G., Roblin, D. W., Wright, N. C., Jones, M. P., Cram, P., Curtis, J. R., Morgan, S. L., Schlechte, J. A., Williams, J. H., Zelman, D. J.
Format:	Journal Article
Language:	English
Published:	London Springer London 01-10-2017 Springer Nature B.V
Subjects:	Absorptiometry, Photon Aged Alabama Brochures Clinical trials Communication Correspondence as Topic Costs Dual energy X-ray absorptiometry Endocrinology Female Georgia Health Care Costs - statistics & numerical data Health Knowledge, Attitudes, Practice Humans Male Medicine Medicine & Public Health Middle Aged Motivation Orthopedics Osteoporosis Osteoporosis - diagnosis Osteoporosis - psychology Patient Education as Topic - economics Patient Education as Topic - methods Patient Outcome Assessment Patient Satisfaction Physician-Patient Relations Rheumatology Short Communication Clinical trials Osteoporosis Patient activation Costs DXA
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Summary:	Summary In a large, pragmatic clinical trial, we calculated the costs of achieving four successful patient-centered outcomes using a tailored patient activation DXA result letter accompanied by a bone health brochure. The cost to achieve one successful outcome (e.g., a 0.5 standard deviation improvement in care satisfaction) ranged from $127.41 to $222.75. Introduction Pragmatic randomized controlled trials (RCTs) should focus on patient-centered outcomes and report the costs for achieving those outcomes. We calculated per person incremental intervention costs, the number-needed-to-treat (NNT), and incremental per patient costs (cost per NNT) for four patient-centered outcomes in a direct-to-patient bone healthcare intervention. Methods The Patient Activation after DXA Result Notification (PAADRN) pragmatic RCT enrolled 7749 patients presenting for DXA at three health centers between February 2012 and August 2014. Interviews occurred at baseline and 52 weeks post-DXA. Intervention subjects received an individually tailored DXA result letter accompanied by an educational bone health brochure 4 weeks post-DXA, while the usual care subjects did not. Outcomes focused on patients (a) correctly identifying their results, (b) contacting their providers, (c) discussing their results with their providers, and (d) satisfaction with their bone healthcare. NNTs were determined using intention-to-treat linear probability models, per person incremental intervention costs were calculated, and costs per NNT were computed. Results Mean age was 66.6 years old, 83.8% were women, and 75.3% were non-Hispanic whites. The incremental per patient cost (costs per NNT) to increase the ability of a patient to (a) correctly identify their DXA result was $171.07; (b) contact their provider about their DXA result was $222.75; (c) discuss their DXA result with their provider was $193.55; and (d) achieve a 0.5 SD improvement in satisfaction with their bone healthcare was $127.41. Conclusion An individually tailored DXA result letter accompanied by an educational brochure can improve four patient-centered outcomes at a modest cost. Trial registration clinicaltrials.gov identifier NCT01507662
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-2 ObjectType-Feature-3 content type line 23
ISSN:	0937-941X 1433-2965
DOI:	10.1007/s00198-017-4113-1