Benefits, Costs and Cost Effectiveness of a Chronic Heart Failure Disease Management Program for Austria – a Decision-Analytic Modeling Study
Author(s)
Jahn B1, Puntscher S2, Santamaria J2, Mühlberger N2, Sroczynski G2, Rochau U2, Siebert S2, Arvandi M2, Moertl D3, Reitter-Pfoertner S4, Kiss N4, Hochwallner C4, Walter E5, Thokala P6, Goehler A7, Siebert U8
1UMIT TIROL - University for Health Sciences and Technology, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Hall i.T., 7, Austria, 2UMIT TIROL - University for Health Sciences and Technology, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Hall i.T., Austria, 3Karl Landsteiner University of Health Sciences, Krems, Austria; Department of Internal Medicine 3, University Hospital, St.Pölten, Austria, 4Competence Center Integrierte Versorgung, Vienna, Austria, 5Institute for Pharmaeconomic Research, Vienna, 9, Austria, 6School of Health and Preventive Research, University of Sheffield, Sheffield, UK, 7MIT Computer Science and Artificial Intelligence Laboratory (CSAIL), Cambridge, MA, USA, 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
Presentation Documents
OBJECTIVES: Heart failure is affecting at least 26 million people worldwide. Disease-management programs (DMP) for patients with chronic heart failure (CHF) can reduce hospital readmission, morbidity, and mortality. Our study commissioned by the Austrian Competence Center Integrated Care (CCIV) aims to evaluate benefits, costs, and cost effectiveness of DMP-CHF interventions for patients with diagnosed CHF in Austria.
METHODS: We developed and validated a Markov-state-transition model to evaluate three DMP-CHF interventions: 1) lifelong program with telemedicine and home-visit options, patients included after diagnosis (DMP-TM_HB_LL), alternatively patients included after CHF-index hospitalization in a 2) three-month telemedicine program (DMP-TM 3M), or 3) 12-month program with home visits (DMP-HB 12M). All DMP-CHFs are compared to usual care (UC). Additionally, a fully incremental analysis was performed. Evaluated outcomes included benefits (life-years gained (LYG), quality-adjusted life years (QALY)gained), number of hospitalizations, costs, and incremental cost-effectiveness ratios (ICER) from the Austrian public health-care system perspective applying a lifetime horizon. Sensitivity analyses included variation of effectiveness parameters, participation, utilities, and costs.
RESULTS: For a cohort of 1,000 69-year-old individuals with diagnosed CHF, compared to UC participation in a DMP-HB 12M led to 323 additional (257 quality-adjusted) life years, in a DMP-TM 3M to 670 additional (534 quality-adjusted) life years and in a DMP-TM_HB_LL to 1,058 additional (851 quality-adjusted) life years. Compared to UC, the ICER of DMP-TM 3M is 3,098 EUR/LYG (3,856 EUR/ QALY). The ICER of DMP–TM_HB_LL compared to DMP – TM 3M is 3,562 EUR/LYG (4,346 EUR/QALY). DMP-HB 12M was dominated. Study results were sensitive, for example, to changes in DMP-doctors’ costs, home visits and telemonitoring participation.
CONCLUSIONS: Based on our results, participation in DMP is more effective than UC. Both the DMP - TM_HB_LL and the DMP-TM 3M are cost effective with an incremental cost-effectiveness ratio of less than 5,000 EUR/QALY.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
EE458
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Medical Devices, Personalized & Precision Medicine