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Cost-effectiveness of a follow-up program for older patients with heart failure: a randomized controlled trial

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Abstract

Purpose

To assess the cost–utility of adding a disease management program (DMP) delivered by geriatric day hospital (GDH) for older patients with heart failure (HF) after hospital discharge.

Methods

117 older HF patients discharged by a geriatric service were randomly assigned to DMP (n = 59) and usual care (UC) (n = 58) groups. The DMP group received health education, therapeutic control and monitoring through both telephone contacts and face-to-face visits at the GDH for 12 months. The UC group received standard health care. The main outcome measures were the costs from the health-care system and societal perspectives and quality-adjusted life-years (QALYs) using EuroQol (EQ-5D-3L). The cost-effectiveness analysis used the package ICEinfer in R 2.13.0.

Results

The mean age was 85 years, and 73% of the patients were women. The mean values of QALYs after 12 months were − 0.083 in DMP and − 0.154 in UC. Each extra QALY gained by the DMP relative to usual care cost was €38,274 and €25,390 from health-care or societal perspective, respectively. An investment of €44,000/QALY (Spanish Health System Threshold) showed a 91 and 85% of probability to be cost-effective from health-care and societal perspectives.

Conclusion

The intervention was moderately cost-effective in delaying deaths and preserving the loss of health-related quality of life in older patients with HF. The study was internationally registered with the ISRCTN10823032.

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Funding

This work was supported in part by the Research Group Grant [GR10127], co-financed by the Regional Government of Extremadura (Spain) and European Union Regional Funds (FEDER). M.A. Hernández-Mocholi was supported by a grant from the Spanish Ministry of Science and Innovation (FPU3839). The funder did not influence the design, methods, subject recruitment, data collections, analysis or preparation of the paper.

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Authors and Affiliations

  1. Geriatric Service, Complejo Hospitalario de Cáceres, Cáceres, Spain

    José L. González-Guerrero & Teresa Alonso-Fernández

  2. Faculty of Sports Sciences, University of Extremadura, Av. Universidad S/N, 10003, Cáceres, Spain

    Miguel A. Hernández-Mocholi & Narcís Gusi

  3. Geriatric Service, Hospital Clínico San Carlos de Madrid, Madrid, Spain

    José M. Ribera-Casado

  4. Department of Patient Management, Complejo Hospitalario de Cáceres, Cáceres, Spain

    Nieves García-Mayolín

Authors
  1. José L. González-Guerrero
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  2. Miguel A. Hernández-Mocholi
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  3. José M. Ribera-Casado
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  4. Nieves García-Mayolín
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  5. Teresa Alonso-Fernández
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  6. Narcís Gusi
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Corresponding authors

Correspondence to José L. González-Guerrero or Narcís Gusi.

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Conflict of interest

None declared.

Ethical approval

This study was approved by the Ethics Committee for Provincial Clinical Research. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

All patients, or their proxies when they had cognitive impairment, signed their previous informed consent.

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Supplementary data:

Supplementary data mentioned in the text is available to subscribers in European Geriatric Medicine online. Supplementary material 1 (DOCX 96 kb)

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González-Guerrero, J.L., Hernández-Mocholi, M.A., Ribera-Casado, J.M. et al. Cost-effectiveness of a follow-up program for older patients with heart failure: a randomized controlled trial. Eur Geriatr Med 9, 523–532 (2018). https://doi.org/10.1007/s41999-018-0074-y

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  • DOI: https://doi.org/10.1007/s41999-018-0074-y

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