Cost-effectiveness of a follow-up program for older patients with heart failure: a randomized controlled trial

• Published in: European geriatric medicine Vol. 9; no. 4; pp. 523 - 532
• Main Authors: González-Guerrero, José L., Hernández-Mocholi, Miguel A., Ribera-Casado, José M., García-Mayolín, Nieves, Alonso-Fernández, Teresa, Gusi, Narcís
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-08-2018
• Subjects: Geriatrics/Gerontology; Internal Medicine; Medicine; Medicine & Public Health; Research Paper; Heart failure; Disease management programs; Elderly patients; Cost-effectiveness
• ISSN: 1878-7657; 1878-7649; 1878-7657
• DOI: 10.1007/s41999-018-0074-y

Purpose
To assess the cost–utility of adding a disease management program (DMP) delivered by geriatric day hospital (GDH) for older patients with heart failure (HF) after hospital discharge.
Methods
117 older HF patients discharged by a geriatric service were randomly assigned to DMP (
n
 = 59) and usual care (UC) (
n
 = 58) groups. The DMP group received health education, therapeutic control and monitoring through both telephone contacts and face-to-face visits at the GDH for 12 months. The UC group received standard health care. The main outcome measures were the costs from the health-care system and societal perspectives and quality-adjusted life-years (QALYs) using EuroQol (EQ-5D-3L). The cost-effectiveness analysis used the package ICEinfer in R 2.13.0.
Results
The mean age was 85 years, and 73% of the patients were women. The mean values of QALYs after 12 months were − 0.083 in DMP and − 0.154 in UC. Each extra QALY gained by the DMP relative to usual care cost was €38,274 and €25,390 from health-care or societal perspective, respectively. An investment of €44,000/QALY (Spanish Health System Threshold) showed a 91 and 85% of probability to be cost-effective from health-care and societal perspectives.
Conclusion
The intervention was moderately cost-effective in delaying deaths and preserving the loss of health-related quality of life in older patients with HF. The study was internationally registered with the ISRCTN10823032.