A computer-guided quality improvement tool for primary health care: cost-effectiveness analysis based on TORPEDO trial data

Bindu Patel; David P Peiris; Anushka Patel; Stephen Jan; Mark F Harris; Tim Usherwood; Kathryn Panaretto; Thomas Lung

doi:10.5694/mja2.50667

A computer-guided quality improvement tool for primary health care: cost-effectiveness analysis based on TORPEDO trial data

Med J Aust. 2020 Jul;213(2):73-78. doi: 10.5694/mja2.50667. Epub 2020 Jun 27.

Authors

Bindu Patel¹, David P Peiris¹, Anushka Patel¹, Stephen Jan¹, Mark F Harris^{2

3}, Tim Usherwood³, Kathryn Panaretto^{4

5}, Thomas Lung¹

Affiliations

¹ The George Institute for Global Health, UNSW Sydney, Sydney, NSW.
² Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW.
³ Sydney Medical School, the University of Sydney, Sydney, NSW.
⁴ Centre for Chronic Disease, University of Queensland, Brisbane, QLD.
⁵ Medical Centre Queensland, University of Technology, Brisbane, QLD.

PMID: 32594567
DOI: 10.5694/mja2.50667

Abstract

Objective: To assess the cost-effectiveness of a computer-guided quality improvement intervention for primary health care management of cardiovascular disease (CVD) in people at high risk.

Design: Modelled cost-effectiveness analysis of the HealthTracker intervention and usual care for people with high CVD risk, based on TORPEDO trial data on prescribing patterns, changes in intermediate risk factors (low-density lipoprotein cholesterol, systolic blood pressure), and Framingham risk scores.

Participants: Hypothetical population of people with high CVD risk attending primary health care services in a New South Wales primary health network (PHN) of mean size.

Intervention: HealthTracker, integrated into health care provider electronic health record systems, provides real time decision support, risk communication, a clinical audit tool, and a web portal for performance feedback.

Main outcome measures: Incremental cost-effectiveness ratios (ICERs): difference in costs of the intervention and usual care divided by number of CVD events averted with HealthTracker.

Results: The estimated numbers of major CVD events over five years per 1000 patients at high CVD risk were lower in PHNs using HealthTracker, both for patients with prior CVD events (secondary prevention; 259 v 267 with usual care) and for those without prior events (primary prevention; 168 v 176). Medication costs were higher and hospitalisation costs lower with HealthTracker than with usual care for both primary and secondary prevention. The estimated ICER for one averted CVD event was $7406 for primary prevention and $17 988 for secondary prevention.

Conclusion: Modelled cost-effectiveness analyses provide information that can assist decisions about investing in health care quality improvement interventions. We estimate that HealthTracker could prevent major CVD events for less than $20 000 per event averted.

Trial registration (torpedo): Australian New Zealand Clinical Trials Registry, ACTRN 12611000478910.

Keywords: Economic models; General practice; Guidelines as topic; Health services research; Preventive medicine; Primary care; Quality of health care; eHealth.

MeSH terms

Cardiovascular Diseases / prevention & control*
Cost-Benefit Analysis*
Decision Support Techniques*
Humans
New South Wales
Primary Health Care*
Primary Prevention / economics
Quality Improvement / organization & administration*
Risk Factors
Secondary Prevention / economics
Software