Utilizing Real World Evidence for Cost-Effectiveness Analysis of the Disease Management Program for Chronic Heart Failure Herzmobil Tirol
Author(s)
Jahn B1, Egelseer-Bruendl T2, Arvandi M3, Puntscher S3, Santamaria J3, Pfeifer B4, Rissbacher C5, Modre-Osprian R6, Neururer S4, Kreiner K7, Siebert U8, Poelzl G9
1UMIT TIROL - University for Health Sciences and Technology, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Hall i.T., 7, Austria, 2Medical University Innsbruck, Clinical Division of Orthopaedics and Traumatology, Innsbruck, Tyrol, Austria, 3UMIT TIROL - University for Health Sciences and Technology, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Hall i.T., Austria, 4UMIT TIROL- University for Health Sciences and Technology, Division for Digital Medicine and Telehealth, Hall i.T, Austria. Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Tyrol, Austria, 5UMIT TIROL - University for Health Sciences and Technology, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Hall i. T. ;Tyrol State Hospital – University Hospital, Innsbruck, Austria, 6TELBIOMED Medizintechnik und IT Service GmbH., Graz, Styria, Austria, 7AIT Austrian Institute of Technology, Graz, Styria, Austria, 8UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria. ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria. Harvard T.H. Chan School of Public Health and Harvard Medical School, Hall in Tirol, 7, Austria, 9Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology, Innsbruck, Tyrol, Austria
Presentation Documents
OBJECTIVES: Health-economic analyses of disease management programs (DMP) for chronic heart failure (CHF) with and without telemedicine have been conducted with considerable variations. HerzMobil Tirol is a 3-month transitional, telemedical assisted, post-discharge DMP (DMP-HMT) for CHF implemented in routine care in Tyrol/Austria. Our study aimed to assess effectiveness and cost effectiveness of the DMP-HMT.
METHODS: We conducted a cost-effectiveness analysis along a retrospective cohort study for DMP-HMT with a propensity-score matched cohort (257 individuals usual care (UC), 251 DMP-HMT) and, one-year follow up (2016-2019). We determined the effectiveness (hospital-free life expectancy, life expectancy, and number of avoided rehospitalizations), costs (DMP, rehospitalizations) and the incremental cost-effectiveness ratio (ICER). Data preparation included two steps: missing value imputation and adjustment for remaining confounding due to imperfect matching. We performed a nonparametric sensitivity analysis with bootstrap sampling (n=5,000 replications), a sensitivity analysis on costs of CHF-rehospitalizations after events that are highly irrelevant for the stated research question and on costs per disease-related diagnosis (DRG) score for rehospitalizations.
RESULTS: Free days, 40 additional life days, and 0.12 avoided hospitalizations per person compared to UC. The average DMP costs are 1,916 EUR/person. Mean rehospitalization costs are 5,551 EUR in DMP-HMT and 6,943 EUR in UC. The ICER of DMP-HMT compared to UC is 4,773 EUR/life-year gained outside the hospital. DMP-HMT was cost saving when "high irrelevant costs" were replaced with average costs.
CONCLUSIONS: Our economic evaluation showed that the DMP HerzMobil Tirol is cost effective compared to UC based on the one-year time follow-up horizon. The DMP was cost-saving in a sensitivity analysis correcting for "high irrelevant costs". Our findings promote a widespread adoption of telemedical assisted DMP for CHF. Further long-term assessment using a decision-analytic model is needed considering upcoming real-world evidence.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
EE306
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Medical Devices, Personalized & Precision Medicine