The Economic Person: Advancing the Evaluation of Person Centred Healthcare Programmes: A Health Economic Perspective

Abstract

Background: Despite the growing body of evidence supporting the benefits of person-centred care (PCC), a gap exists in how these benefits are evaluated within health economics. Overall aim: The aim of this thesis is to advance the evaluation of person-centred healthcare programmes from a health economics perspective, thereby supporting informed decision-making. Methods: Study I conducted a cost-utility analysis of a remote PCC add-on intervention for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) from a societal perspective. Study II was a pre-planned companion analysis that evaluated health equity based on data from a published systematic review of the costs and outcomes in health economic evaluations of PCC. Study III performed a two-round modified Delphi study aimed at developing a core outcome set (COS) for the evaluation of healthcare programmes adopting centredness. Study IV applied group-based trajectory modelling in a cost-consequence framework to evaluate multiple outcome measures within a health economic evaluation. Results: Study I found that the remote PCC intervention for patients with COPD and CHF was more effective and less costly than usual care from a societal perspective (i.e., dominant). Study II showed that across the 41 included papers, none reported disability status, end-of-life status, or associated diseases and symptoms, with only five papers conducting subgroup analyses. Study III identified a COS of 36 outcomes important to different stakeholder groups, divided into six categories: general health, capabilities and support systems, care processes, organisational, economic and eHealth. Study IV identified four trajectory groups, High, Moderate, Low, and No Improvement. The High Improvement group had the lowest costs and best baseline values across all included outcome measures. Conclusion: PCC demonstrates value within conventional cost-effectiveness frameworks, but its full benefits extend beyond healthcare costs and health-related quality of life. Economic evaluations should therefore adopt broader perspectives, include outcomes important to different stakeholder groups, and better address equity through comprehensive reporting and subgroup analyses. Such approaches would provide a more complete assessment of the value of PCC and support informed healthcare decision-making.