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Cost-Effectiveness of a Home Visit Program for Patients with Heart Failure in Brazil: Evidence from a Randomized

Karen Brasil Ruschel1, Eneida R Rabelo-Silva2, Luis Eduardo Rohde3

  • 1Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Institute for Health Technology Assessment (IATS/ CNPq), Porto Alegre, Rio Grande do Sul, Brazil.

Value in Health Regional Issues
|May 14, 2018
PubMed

Insights

Nurse-led home visits for heart failure (HF) patients in Brazil reduced hospital readmissions. This intervention proved cost-effective in the public system and dominant in the private system, offering patient benefits and financial incentives.

Area of Science:

  • Health Economics
  • Nursing Interventions
  • Cardiovascular Disease Management

Background:

  • Heart failure (HF) management presents significant healthcare costs and readmission challenges.
  • Optimizing patient care pathways is crucial for improving outcomes and reducing financial burdens.
  • Nurse-led interventions offer potential for enhanced patient support and disease management.

Purpose of the Study:

  • To evaluate the cost-effectiveness of a nurse-led home visit (HV) intervention compared to standard HF management.
  • To assess the intervention's impact on hospital readmissions and all-cause mortality over 24 weeks.
  • To analyze the economic implications within both public and private healthcare systems in Brazil.

Main Methods:

  • A randomized clinical trial (RCT: NCT01213875) was conducted in Brazil.
  • The intervention involved four home visits and four telephone calls by nurses for HF patients.
  • Cost-effectiveness was determined using the incremental cost-effectiveness ratio (ICER), focusing on composite endpoints of ER visits, hospital readmissions, or all-cause death.

Main Results:

  • The nurse-led HV intervention significantly reduced the composite endpoint (RR 0.73; P = 0.049).
  • From the Public Healthcare System (PHS) perspective, the ICER was R$585 per hospital readmission visit prevented, indicating greater cost.
  • Within the private healthcare system, HVs were associated with lower costs and reduced readmission rates, demonstrating a dominant cost-effectiveness profile.

Conclusions:

  • Nurse-led home visits for HF patients in Brazil exhibit a favorable cost-effectiveness profile within the PHS.
  • The intervention was found to be dominant (lower cost, better outcomes) in the private healthcare system.
  • Implementing this program offers potential benefits for patients and financial incentives for healthcare administrators.
Abstract

Keywords:
cost-effectivenessheart failurehome visitnursing

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