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Open Access 01-12-2018 | Research article

Value co-creation in healthcare: evidence from innovative therapeutic alternatives for hereditary angioedema

Authors: Rosanna Spanò, Nadia Di Paola, Maria Bova, Alessandro Barbarino

Published in: BMC Health Services Research | Issue 1/2018

Abstract

Background

Our research focuses on the co-creation of value in healthcare with reference to a case of hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE). Our work is mainly based on the concept of value co-creation in healthcare. The aim of this study is to assess the impact of an alternative treatment strategy – self-administration – by focusing on treatment outcomes and costs to understand if innovative therapeutic solutions can create value for patients and healthcare systems.

Methods

This paper compares home-based and hospital-based therapeutic strategies (independent of treatment type) with a cost minimization analysis. It encompasses compliance issues and focuses on both payer and societal perspectives, also benefiting from an operationalization of the service-dominant logic model for healthcare delivery. Data were collected over a 6-month period (August 2014–January 2015) through monthly patient interviews. Archival data were used for variable measurement.

Results

Thirty-nine out of 62 patients enrolled in the study, experienced at least one HAE attacks, equally distributed between home and hospital-based strategies. No evidence of correlation between therapeutic strategy and disease severity score (p = 0.351), compliance (p = 0.399), and quality of life (p = 0.971), were found. Total direct cost per attack amounts to € 1224 for home-based strategy with respect to € 1454 for hospital-based strategy, with a savings of € 230. The economic advantage of the home-based strategy almost doubles if the societal perspective was considered due to a further savings of €169 (less missed work/school days and no travel expenses).

Conclusions

Our study suggests that home-based therapies represent a feasible strategy for managing C1-INH-HAE and may result in lower costs and increased value for both patients and the healthcare systems. The findings are relevant to the debate on and extend the extant literature to provide a broader view of value co-creation dynamics for home-based therapies in healthcare and their positive effects. The insights are relevant to practitioners and policy makers.

This score ranges from 0 to 10 (from the lowest to the highest disease severity) and is based on the patient’s age at disease onset, the number of organs ever affected, and the need for long-term prophylaxis: age at onset 0–5 years (3 points), age at onset 6–10 years (2 points), age at onset, 11–20 years (1 point), age at onset > >20 years (0 points); skin edema ever (1 point); painful abdominal edema ever (2 points); laryngeal edema ever (2 points); other clinical manifestations (1 point); long-term prophylaxis (1 point).

C1-INH concentrate occupies the same clinical position as icatibant; there is no head-to-head clinical evidence to suggest that one of these interventions is more effective than the other, so neither is generally indicated as a first line option (although perceptions of superiority of one or the other may exist among clinicians). Thus, for the treatment comparison, the clinical claim is that C1-INH concentrate is non-inferior to icatibant in efficacy and safety for acute HAE attacks in adults and adolescents. This is based on the ASCIA management algorithm, which recommends either icatibant, or C1-INH concentrate for acute attacks. The appropriate economic evaluation would be a cost-minimization analysis. See both Australian and German Guidelines.

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Title: Value co-creation in healthcare: evidence from innovative therapeutic alternatives for hereditary angioedema
Authors: Rosanna Spanò
Nadia Di Paola
Maria Bova
Alessandro Barbarino
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-018-3389-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Value co-creation in healthcare: evidence from innovative therapeutic alternatives for hereditary angioedema

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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