Cost-Effectiveness of Transitional Care Services After Hospitalization With Heart Failure.
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BORIS DOI
Publisher DOI
PubMed ID
31986526
Description
Background
Patients with heart failure (HF) discharged from the hospital are at high risk for death and rehospitalization. Transitional care service interventions attempt to mitigate these risks.
Objective
To assess the cost-effectiveness of 3 types of postdischarge HF transitional care services and standard care.
Design
Decision analytic microsimulation model.
Data Sources
Randomized controlled trials, clinical registries, cohort studies, Centers for Disease Control and Prevention life tables, Centers for Medicare & Medicaid Services data, and National Inpatient Sample (Healthcare Cost and Utilization Project) data.
Target Population
Patients with HF who were aged 75 years at hospital discharge.
Time Horizon
Lifetime.
Perspective
Health care sector.
Intervention
Disease management clinics, nurse home visits (NHVs), and nurse case management.
Outcome Measures
Quality-adjusted life-years (QALYs), costs, net monetary benefits, and incremental cost-effectiveness ratios (ICERs).
Results of Base-Case Analysis
All 3 transitional care interventions examined were more costly and effective than standard care, with NHVs dominating the other 2 interventions. Compared with standard care, NHVs increased QALYs (2.49 vs. 2.25) and costs ($81 327 vs. $76 705), resulting in an ICER of $19 570 per QALY gained.
Results of Sensitivity Analysis
Results were largely insensitive to variations in in-hospital mortality, age at baseline, or costs of rehospitalization. Probabilistic sensitivity analysis confirmed that transitional care services were preferred over standard care in nearly all 10 000 samples, at willingness-to-pay thresholds of $50 000 or more per QALY gained.
Limitation
Transitional care service designs and implementations are heterogeneous, leading to uncertainty about intervention effectiveness and costs when applied in particular settings.
Conclusion
In older patients with HF, transitional care services are economically attractive, with NHVs being the most cost-effective strategy in many situations. Transitional care services should become the standard of care for postdischarge management of patients with HF.
Primary Funding Source
Swiss National Science Foundation, Research Council of Norway, and an Intermountain-Stanford collaboration.
Patients with heart failure (HF) discharged from the hospital are at high risk for death and rehospitalization. Transitional care service interventions attempt to mitigate these risks.
Objective
To assess the cost-effectiveness of 3 types of postdischarge HF transitional care services and standard care.
Design
Decision analytic microsimulation model.
Data Sources
Randomized controlled trials, clinical registries, cohort studies, Centers for Disease Control and Prevention life tables, Centers for Medicare & Medicaid Services data, and National Inpatient Sample (Healthcare Cost and Utilization Project) data.
Target Population
Patients with HF who were aged 75 years at hospital discharge.
Time Horizon
Lifetime.
Perspective
Health care sector.
Intervention
Disease management clinics, nurse home visits (NHVs), and nurse case management.
Outcome Measures
Quality-adjusted life-years (QALYs), costs, net monetary benefits, and incremental cost-effectiveness ratios (ICERs).
Results of Base-Case Analysis
All 3 transitional care interventions examined were more costly and effective than standard care, with NHVs dominating the other 2 interventions. Compared with standard care, NHVs increased QALYs (2.49 vs. 2.25) and costs ($81 327 vs. $76 705), resulting in an ICER of $19 570 per QALY gained.
Results of Sensitivity Analysis
Results were largely insensitive to variations in in-hospital mortality, age at baseline, or costs of rehospitalization. Probabilistic sensitivity analysis confirmed that transitional care services were preferred over standard care in nearly all 10 000 samples, at willingness-to-pay thresholds of $50 000 or more per QALY gained.
Limitation
Transitional care service designs and implementations are heterogeneous, leading to uncertainty about intervention effectiveness and costs when applied in particular settings.
Conclusion
In older patients with HF, transitional care services are economically attractive, with NHVs being the most cost-effective strategy in many situations. Transitional care services should become the standard of care for postdischarge management of patients with HF.
Primary Funding Source
Swiss National Science Foundation, Research Council of Norway, and an Intermountain-Stanford collaboration.
Date of Publication
2020-02-18
Publication Type
Article
Language(s)
en
Contributor(s)
Øien, Henning | |
Carmichael, Harris L | |
Heidenreich, Paul | |
Owens, Douglas K | |
Goldhaber-Fiebert, Jeremy D |
Additional Credits
Series
Annals of internal medicine
Publisher
American College of Physicians
ISSN
0003-4819
Access(Rights)
restricted