Although 30% of the population lives rurally, only 2.4% of NHMRC funding goes toward research specifically aimed to deliver health benefits to people living in rural or remote Australia. A study conducted by researchers at the UQ Centre of the Business and Economics of Health in partnership with the Spinifex Network evaluated the return on investment of an intervention to embed a telehealth intervention within primary healthcare for reducing diet-related cardiovascular disease risk in adults living in rural and remote regions and found that the intervention is potentially cost saving.
Authors: Haitham Tuffaha1, Stephen Birch1
- The University of Queensland Centre for the Business and Economics of Health
Demonstrating its value for money may be helpful to make a case for more funding to support rural and remote health research. The Value of Research framework estimated the return on investment of the randomised controlled trial (RCT) prospectively. The expected value of research is the sum of the expected value of the RCT in reducing decision uncertainty (i.e., informing decision making) and the expected value of the RCT in improving the implementation of the intervention in practice. A decision model estimated and compared the long-term costs and effects of the simulated cohorts in the RCT (i.e., intervention and control). Results showed that the intervention is potentially cost saving and more effective than standard care. However, the probability of the intervention being cost-effective is only 56%, suggesting that a decision based on prior evidence (i.e., before the new RCT) might be uncertain.
The expected value of the proposed RCT in reducing decision uncertainty for a population of 450,000 eligible patients in rural and regional Australia is estimated to be $20.7 million. If the proposed RCT results confirm the expected benefits of the intervention, the implementation of the intervention in practice should improve. With a 10% improvement in the uptake of the intervention, the expected monetary benefit of improved implementation is about $39.5 million. Therefore, the total expected monetary benefit of the RCT is around $60.2 million. Comparing this figure with the proposed RCT budget of $1.03 million, the expected return on research investment is about 5800%. As such, the proposed RCT is potentially value for money, with each $1 of funding, expecting a return of $58.
This study is one of the first in Australia to estimate prospectively the return on investment of clinical trials using a value of information framework. An explicit comparison of the benefits and costs of clinical trials is essential to allocate research resources wisely to maximise return on research investment. The RCT is expected to inform policy related to access to cost-effective clinical care for cardiovascular disease prevention.
Figure 1: Value of Research Framework