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A Cost-Effective Analysis of Motivational Interviewing with Palliative Care Versus Usual Care: Results from the Living Well Project

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Abstract

Little is known about the impact of early palliative care (EPC) combined with motivational interviewing (MI) for persons living with AIDS (PWA). We compared the cost and quality-adjusted life-years (QALYs) of EPC + MI (n = 61) versus usual care (UC) (n = 60) for patients with AIDS, not on antiretroviral medications, enrolled into the Living Well Project trial. Data on clinic, emergency department, and hospital visits were collected through self-report and billing records. Risk-adjusted average annual health care costs were estimated using a generalized linear model with a gamma log-link function. QALYs were calculated using the SF-12v2. Cost-effectiveness was defined as cost per QALY gained. Estimated intervention costs were $165 per participant. EPC + MI reduced costs by 33% (AOR = 0.67; CI 95%: 0.15, 0.93). QALYs did not differ between groups. Results suggest EPC + MI for PWA is cost-saving and maintains quality of life compared to UC due to reduced hospital and ED costs.

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Data Availability

Data are not publicly available due to nature. However, the authors are willing to share data in that costs are derived.

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Funding

This research was funded by NINR/NIH R01NR014054 (PIs Holstad, M & Quest, T), and received partial support by the Emory Center for AIDS Research (P30AI050409). This clinical trial is registered at ClinicalTrials.gov number NCT01848483.

Author information

Authors and Affiliations

  1. Department of Health Policy and Management, Rollins School of Public Health of Emory University, Atlanta, Georgia

    Victoria Phillips

  2. Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia

    Tammie E. Quest

  3. Office of Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia

    Melinda Higgins

  4. Department of Infectious Disease, Emory University School of Medicine, Atlanta, Georgia

    Vincent C. Marconi

  5. Georgia State University Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, Georgia

    Monique S. Balthazar

  6. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia

    Marcia Holstad

  7. Rollins School of Public Health of Emory University, 1518 Clifton Road, Room 614, 30322, Atlanta, GA, USA

    Victoria Phillips

Authors
  1. Victoria Phillips
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  2. Tammie E. Quest
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  4. Vincent C. Marconi
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  5. Monique S. Balthazar
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  6. Marcia Holstad
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Contributions

Victoria Phillips: Study design, data collection, data analysis, writing of manuscript. Tammie E. Quest, MD: Project Co-Pi, assistance with data interpretation and writing of manuscript. Melinda Higgins: assistance with data collection and data analysis. Vincent C. Marconi, MD: Project Co-Pi, assistance with data interpretation and writing of manuscript. Monique S. Balthazar, DNP, PhD, FNP-BC, AGACNP-BC: assistance with data collection and writing of manuscript. Marcia Holstad, PhD, FNP-BC6: Project PI, study design, data collection and writing of manuscript.

Corresponding author

Correspondence to Victoria Phillips.

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No authors have a conflict of interest in relation to findings of our article.

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This study was approved by the Emory Institutional Review Board.

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Phillips, V., Quest, T.E., Higgins, M. et al. A Cost-Effective Analysis of Motivational Interviewing with Palliative Care Versus Usual Care: Results from the Living Well Project. AIDS Behav 27, 1259–1268 (2023). https://doi.org/10.1007/s10461-022-03862-8

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