Richardson and coworkers assessed the cost effectiveness of the Expert Patients Program intervention compared to usual treatment. The design featured randomized controlled trial design with waiting list control conducted in community settings in England. Patients with a wide range of self-defined long-term conditions were exposed to the chronic disease self-management program (CDSMP), a lay-led self-care group involving six weekly sessions to teach self-care support skills. The outcome measures were costs estimated over a 6-month period from a societal perspective. In addition, the study examined health outcomes estimated in terms of quality adjusted life years (QALYs) generated by patients' responses at baseline and 6-month follow-up. The intervention group was associated with better patient outcomes, at slightly lower cost. Specifically, the intervention group has a 0.020 QALY gain compared with the control group, and a reduced cost of around 27 pounds per patient. While the QALYs gained are small in absolute terms, an additional 0.02 QALY is equivalent to an extra one week of perfect health per year. When the value of a QALY is 20,000 pounds the expert patients program has a probability of 94% of being cost effective. Indeed, for all plausible values of willingness-to-pay for a QALY the intervention group is more likely to be cost effective than the control group.

WHAT THE STUDY MAY MEAN TO YOU: The authors concluded that the expert patients intervention evaluated in the trial is likely to provide a cost effective alternative to usual care in people with long-term conditions. The results of the study add to the considerable amount of evidence favoring use of the CDSMP with chronically ill patients. It is likely that even stronger data would have emerged had the subjects been followed for a longer period of time.

G Richardson et al. Cost effectiveness of the Expert Patients Programme (EPP) for patients with chronic conditions. Journal of Epidemiology & Community Health, 2008;62:361-367.