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The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial
  1. Anne Kennedy1,
  2. David Reeves1,
  3. Peter Bower1,
  4. Victoria Lee1,
  5. Elizabeth Middleton1,
  6. Gerry Richardson2,
  7. Caroline Gardner1,
  8. Claire Gately1,
  9. Anne Rogers1
  1. 1National Primary Care Research and Development Centre, University of Manchester, Manchester, UK
  2. 2Centre for Health Economics, University of York, York, UK
  1. Correspondence to:
 Dr A Kennedy
 National Primary Care Research and Development Centre, 5th Floor, Williamson Building, University of Manchester, Manchester M13 9PL, UK; anne.p.kennedy{at}


Objective: Supporting patients’ self care could have a major effect on the management of long-term conditions, which has led to worldwide interest in effective self care interventions. In England, self care support is being developed through the “Expert Patients Programme”, which provides lay-led generic courses to improve patients’ self care skills. However, the clinical and cost effectiveness of such courses remains unclear.

Methods: Two-arm pragmatic randomised controlled trial design with waiting list control in community settings in England. 629 patients with a wide range of self-defined long-term conditions were studied. The lay-led self care support group involved 6-weekly sessions to teach self care skills. Primary outcomes were self-efficacy, reported energy and routine health services utilisation at 6 months. A cost-effectiveness analysis was also conducted.

Results: Patients receiving immediate course access reported considerably greater self-efficacy and energy at 6-month follow-up, but reported no statistically significant reductions in routine health services utilisation over the same time period. The cost-effectiveness analysis showed that patients receiving immediate course access reported considerably greater health related quality of life, and a small reduction in costs. If a quality adjusted life year was valued at £20 000 ($39 191; €30 282), there was a 70% probability that the intervention was cost effective.

Conclusions: Lay-led self care support groups are effective in improving self-efficacy and energy levels among patients with long-term conditions, and are likely to be cost effective over 6 months at conventional values of a decision-maker’s willingness to pay. They may be a useful addition to current services in the management of long-term conditions.

  • CDSMP, chronic disease self management programme
  • EPP, Expert Patients Programme
  • NHS, National Health Service
  • REPORT, Research into Expert Patients—Outcomes in a Randomised Trial
  • QALY, quality-adjusted life year

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  • Funding: The REPORT study was funded by the Department of Health. The funding body was not involved in the design, analysis and reporting of the REPORT trial beyond commissioning reviews of the protocol, and checking the accuracy of certain facts and material included in the final draft.

  • Competing interests: None.

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