Cost-Effectiveness of Transitional Care Services After Hospitalization With Heart Failure.

Blum, Manuel R; Øien, Henning; Carmichael, Harris L; Heidenreich, Paul; Owens, Douglas K; Goldhaber-Fiebert, Jeremy D (2020). Cost-Effectiveness of Transitional Care Services After Hospitalization With Heart Failure. Annals of internal medicine, 172(4), pp. 248-257. American College of Physicians 10.7326/M19-1980

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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.


To assess the cost-effectiveness of 3 types of postdischarge HF transitional care services and standard care.


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



Health care sector.


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.


Transitional care service designs and implementations are heterogeneous, leading to uncertainty about intervention effectiveness and costs when applied in particular settings.


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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Blum, Manuel


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




American College of Physicians




Tobias Tritschler

Date Deposited:

19 Feb 2020 09:05

Last Modified:

05 Dec 2022 15:36

Publisher DOI:


PubMed ID:





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