MODELLING THE COST-EFFECTIVENESS OF INTERVENTIONS FOR INDIVIDUALS WITH MULTIMORBIDITY IN NEW ZEALAND: A DISCRETE EVENT SIMULATION...
Author(s)
Yen Wei Lim, MSc (Pharmacoeconomics)1, Ross Wilson, PhD1, Dee Mangin, PhD2, J. Haxby Abbott, PhD1.
1Department of Surgery and Critical Care, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand, 2Department of Primary Care and Clinical Simulation, University of Otago, Christchurch, New Zealand.
1Department of Surgery and Critical Care, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand, 2Department of Primary Care and Clinical Simulation, University of Otago, Christchurch, New Zealand.
OBJECTIVES: Multimorbidity (the co-existence of two or more chronic health conditions in an individual) is a growing global issue impacting patients, caregivers, and society. This study aimed to evaluate the cost-effectiveness of the medicine management (MM), support for self-management (SSM), and care coordination plus support for self-management (CC+SSM) interventions used to manage individuals with multimorbidity, as compared to usual care, from the perspective of the health system in New Zealand (NZ).
METHODS: A discrete event simulation model was used to simulate adult individuals with multimorbidity in NZ. Individuals receiving each of the three interventions alongside usual care were modelled for health events (hospitalisation, emergency department visits, general practitioner visits, and outpatient visits) until death or age 100. Real-world data on event rates, HRQoL, and costs were extracted from the Statistics NZ’s Integrated Data Infrastructure datasets or calculated using reference prices. Intervention effectiveness data from our previous systematic review were used to model event rate changes. All costs were in 2025 NZ dollars (NZD), and both the costs and quality-adjusted life-years (QALYs) were discounted at 3.5%. Univariate and probability sensitivity analyses assessed the model uncertainties. The simulation was programmed in R using the {descem} package.
RESULTS: In the primary analysis, the incremental cost-effectiveness ratio (ICER) for MM interventions was estimated at NZD18,942 per QALY, as compared to usual care alone. SSM interventions were found to have an ICER of NZD22,728 per QALY. Both the interventions were deemed cost-effective based on the NZ per capita gross domestic product threshold (~NZD80,000 per QALY). In contrast, CC+SSM interventions were not cost-effective (dominated), having an ICER of -NZD252,583 per QALY.
CONCLUSIONS: The results suggest that both the MM and SSM interventions are cost-effective compared with usual care alone. These findings indicate that policymakers may consider the adoption of these interventions for the management of individuals with multimorbidity in NZ.
METHODS: A discrete event simulation model was used to simulate adult individuals with multimorbidity in NZ. Individuals receiving each of the three interventions alongside usual care were modelled for health events (hospitalisation, emergency department visits, general practitioner visits, and outpatient visits) until death or age 100. Real-world data on event rates, HRQoL, and costs were extracted from the Statistics NZ’s Integrated Data Infrastructure datasets or calculated using reference prices. Intervention effectiveness data from our previous systematic review were used to model event rate changes. All costs were in 2025 NZ dollars (NZD), and both the costs and quality-adjusted life-years (QALYs) were discounted at 3.5%. Univariate and probability sensitivity analyses assessed the model uncertainties. The simulation was programmed in R using the {descem} package.
RESULTS: In the primary analysis, the incremental cost-effectiveness ratio (ICER) for MM interventions was estimated at NZD18,942 per QALY, as compared to usual care alone. SSM interventions were found to have an ICER of NZD22,728 per QALY. Both the interventions were deemed cost-effective based on the NZ per capita gross domestic product threshold (~NZD80,000 per QALY). In contrast, CC+SSM interventions were not cost-effective (dominated), having an ICER of -NZD252,583 per QALY.
CONCLUSIONS: The results suggest that both the MM and SSM interventions are cost-effective compared with usual care alone. These findings indicate that policymakers may consider the adoption of these interventions for the management of individuals with multimorbidity in NZ.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE78
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Geriatrics, STA: Multiple/Other Specialized Treatments