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Cost/utility ratio in chronic heart failure: comparison between heart failure management program delivered by
Soccorso Capomolla1, Oreste Febo, Monica Ceresa
1Fondazione Salvatore Maugeri, IRCCS, Dipartimento di Cardiologia, Istituto Scientifico di Montescano, Montescano, Pavia, Italy. scapomolla@fsm.it
Insights
A day-hospital heart failure management program significantly reduced hospital readmissions and cardiac death in chronic heart failure patients. This effective strategy is also cost-effective, offering societal value.
Area of Science:
- Cardiology
- Health Services Research
- Public Health
Background:
- Multidisciplinary approaches can prevent approximately 50% of heart failure readmissions.
- Evidence-based outpatient heart failure management strategies require further evaluation for performance, effectiveness, and cost-utility.
Purpose of the Study:
- To compare the effectiveness and cost-utility of a day-hospital (DH) heart failure management program versus usual care for chronic heart failure (CHF) outpatients.
Main Methods:
- 234 CHF outpatients were randomized to either DH management (112) or usual community care (122).
- Evaluated outcomes included readmission rates, functional parameters (NYHA class, ejection fraction), and hard outcomes (cardiac death, transplantation).
- Cost-utility ratios were compared between the two management strategies.
Main Results:
- DH patients had significantly fewer hospital readmissions (13 vs. 78) and cardiac deaths (2.7% vs. 17.2%) compared to usual care over 12 months.
- DH management led to significant improvements in New York Heart Association functional class (23% improved vs. 11% worsened).
- The cost-utility ratios were similar ($2,244 for DH vs. $2,409 for usual care), with DH management showing a cost savings of $1,068 per quality-adjusted life year gained.
Conclusions:
- A heart failure outpatient management program delivered by a day-hospital effectively reduces mortality and morbidity in CHF patients.
- This DH management strategy is cost-effective and provides equitable value from a societal perspective.
Objective:
This study compared the effectiveness and cost/utility ratio between a heart failure (HF) management program delivered by day-hospital (DH) and usual care in chronic heart failure (CHF) outpatients.
Background:
Previous studies showed that about 50% of readmissions for CHF can be prevented by a multidisciplinary approach. However, the performance, effectiveness, and cost/utility ratio of a process of HF outpatient management related to evidence-based medicine have not been considered.
Methods:
A total of 234 prospective patients discharged by a HF Unit were randomized to two management strategies: 122 patients to usual community care and 112 patients to a HF management program delivered by the DH. Management (rate of readmissions, therapeutic interventions), functional parameters (New York Heart Association [NYHA] functional class, left ventricular diameters, and ejection fraction, deceleration time of early diastolic mitral flow, peak oxygen uptake, and mitral regurgitation) and hard outcomes (cardiac death and urgent cardiac transplantation) were evaluated. The cost/utility ratios of the two strategies were compared.
Results:
After 12 +/- 3 months of follow-up, the individual rate access in DH was 5.5 +/- 3.8 days. The DH subjects were readmitted to the hospital less frequently than were the usual-care group patients (13 vs. 78, p < 0.00001). Patients allocated to usual-care management showed heterogeneous changes in NYHA functional class (13% improved and 16% worsened p = NS); In contrast, the DH group showed significant changes in NYHA functional class (23% improved and 11% worsened, p < 0.009). Hard cardiac events in the one-year follow-up occurred in 25/234 (10.6%) patients; cardiac death occurred in 21/122 (17.2%) of the community group and in 3/112 (2.7%) in the DH group (p < 0.0007). One DH patient underwent urgent transplantation. Comparison of the two managerial models by Cox regression analysis showed that DH management significantly protected against the appearance of hard events (relative risk [RR] 0.17; confidence interval [CI] 0.06 to 0.66). The cost/utility ratio of the two management strategies was similar (usual care $2,409 vs. DH $2,244). The incremental analysis revealed a cost savings of $1,068 for each quality-adjusted life year gained. The cost/utility ratio for the integration of DH management of CHF was $19,462 (CI $13,904 to $34,048).
Conclusions:
A heart failure outpatient management program delivered by a DH can reduce mortality and morbidity of CHF patients. This management strategy is cost-effective and has an equitable value from a societal point of view.
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