Content area
Abstract
ABSTRACT
Background
In the United Kingdom, at least 1.9 million people are estimated to have experienced long Covid, of which 1.3 million have symptoms lasting for more than a year. The Long CovId Personalised Self‐managemenT support EvaluatioN (LISTEN) trial evaluated the effectiveness and cost‐effectiveness of a co‐designed personalised self‐management support intervention for non‐hospitalised people living with long Covid.
Methods
We conducted a pragmatic, multicentre, two‐arm, parallel group and superiority randomised controlled trial for people who had experienced at least one long Covid symptom for 12 weeks or longer. A cost–utility analysis was undertaken alongside the LISTEN trial from both a UK National Health Service (NHS) and personal social services (PSS) and a societal perspective. Implementation costs were determined from study records, and quality of life and health and care resource use were collected by questionnaire at 6‐week and 3‐month follow‐ups. Incremental net monetary benefit (INMB) analyses evaluated the cost‐effectiveness of the intervention at a range of willingness‐to‐pay thresholds.
Results
A total of 544 participants were included in the health economic analysis, of which 62.5% had complete data. The average cost of delivering the LISTEN intervention was £846 per participant. At 3‐month follow‐up, mean quality‐adjusted life years (QALYs) were 0.005 (95% CI −0.004 to 0.014) greater for participants receiving the LISTEN intervention compared to usual care. From the NHS and PSS perspective, total adjusted mean costs were £491 (95% CI, £128 to £854) lower in the usual care arm. From the societal perspective, participants in the usual care arm lost more hours of work and usual activities and received more informal care, with the LISTEN intervention dominating usual care.
Conclusions
At accepted UK thresholds, the LISTEN intervention was not cost‐effective from an NHS and PSS perspective, but it was found to be cost‐effective from a societal perspective due to the impact of long Covid on work, informal care and usual activities. Further research is required to understand the costs and benefits of self‐management support for longer‐term horizons.
Patient and Public Contribution
We are grateful for the contributions of the LISTEN Public and Patient Involvement and Engagement group comprising seven people (Anne Domeney, Ian Patel, Carol Rowe, Judith Parsons, Rebecca Beltran, Elizabeth Treadwell and Maria Ines de Sousa de Abreu) with long Covid who supported co‐design, communications, trial recruitment and dissemination activities.
Trial Registration
ISRCTN36407216, registered 27 January 2022.
Details
Intervention;
Quality of care;
Management;
Questionnaires;
Health care expenditures;
Self evaluation;
Quality of life;
Social services;
Health services;
Registration;
Cost analysis;
Recruitment;
Working hours;
Effectiveness;
Self-efficacy;
Customization;
Informal care;
Costs;
Long COVID;
Cost of living;
Books;
Cost benefit analysis;
Opportunity costs;
Co-design;
Thresholds;
Dissemination;
Symptoms;
Patient participation;
Patients;
Utility functions
; Sewell, Bernadette 2 ; Busse‐Morris, Monica 3 ; Edwards, Adrian 4 ; Jones, Fiona 5 ; Leggat, Fiona 6
; Pallman, Philip 3 ; Fitzsimmons, Deborah 2 1 Swansea Trials Unit, Swansea University, Swansea, UK, Swansea Centre for Health Economics, Swansea University, Swansea, UK
2 Swansea Centre for Health Economics, Swansea University, Swansea, UK
3 Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
4 PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK, Wales COVID‐19 Evidence Centre, Cardiff, UK
5 Population Health Research Institute, St George's, University of London, London, UK, Kingston University London, London, UK, Bridges Self‐Management, London, UK
6 Population Health Research Institute, St George's, University of London, London, UK