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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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Blum, Manuel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0003-4819

Publisher:

American College of Physicians

Language:

English

Submitter:

Christine Baumgartner

Date Deposited:

19 Feb 2020 09:05

Last Modified:

13 May 2020 01:32

Publisher DOI:

10.7326/M19-1980

PubMed ID:

31986526

BORIS DOI:

10.7892/boris.139776

URI:

https://boris.unibe.ch/id/eprint/139776

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