The PEANUT (Phone Education About New or Underused Therapies) Trial is an ongoing, NHLBI-funded randomized, controlled, effectiveness study that uses interactive voice-telephone response (IVR) technology as a low-cost intervention to enhance therapeutic adherence. Preliminary evidence in more than 14,000 subjects suggests a positive effect of the IVR intervention, so we now aim to extend this parent study by performing a full economic evaluation of the intervention using data from the trial and further longitudinal follow-up data on the participants. A formal and rigorous analysis of the costs and relative value for money of this intervention is crucial to the informed translation of findings to other settings. The parent study (PEANUT) includes a cost analysis that will provide good information on the costs of developing, implementing and replicating the IVR intervention at other sites. Our primary specific aim with these ancillary funds is to develop and refine a decision model that can be used to estimate the costs and benefits from the parent trial. Additionally, we aim to estimate the return-on-investment of IVR technology (i.e. cost-offsets), estimate and value quality of life and utility changes, productivity changes, and provider burden using a value of information framework. Our analysis will take the payer perspective. We will construct a decision model (Markov model). The decision model will be populated largely from estimates gained from the parent trial, but will also include further data gained from patient survey, and event rate estimates from the literature and additional data analysis on KPNW members with asthma and COPD. We will conduct a survey of about 12,000 individuals included in the parent study;these survey results will inform transition probabilities for the decision model, and will provide quality of life estimates (utilities) and productivity changes associated with the intervention. Our results will allow decision makers access to critical information that explicitly detail the trade-offs that come with implementing the IVR system by putting the results into a metric (cost/QALY) that is comparable across disease sates and interventions. This comparison across disease states is important in the era of constrained budgets in health care;if monies are spent on one intervention, they are not available for other (potentially more efficient) uses. The return-on-investment will allow decision makers to assess the affordability of the intervention. Our study will be carried out in parallel to the parent study, and will take advantage of the considerable economies of scale that exist with project management, data analyst, and investigator effort. We plan to complete the study within an 18-month period, to run concurrently with the parent trial.

Public Health Relevance

This study is an extension of a randomized study that is testing the effect of automated, interactive telephone calls on increasing medication adherence in patients with asthma and other lung diseases. We will carry out an evaluation of the cost-effectiveness (efficiency) of the automated phone calls.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Special Emphasis Panel (ZHL1-CSR-G (O1))
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Smith, Robert A
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Kaiser Foundation Research Institute
United States
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