OBJECTIVE: To evaluate the cost-effectiveness of a telephonic disease management (DM) intervention in heart failure (HF). STUDY DESIGN: Randomized controlled trial of telephonic DM among 1069 community-dwelling patients with systolic HF (SHF) and diastolic HF performed between 1999 and 2003. The enrollment period was 18 months per subject. METHODS: Bootstrap-resampled incremental cost-effectiveness ratios (ICERs) were computed and compared across groups. Direct medical costs were obtained from a medical record review that collected records from 92% of patients; 66% of records requested were obtained. RESULTS: Disease management produced statistically significant survival advantages among all patients (17.4 days, P = .04), among patients with New York Heart Association (NYHA) class III/IV symptoms (47.7 days, P = .02), and among patients with SHF (24.2 days, P = .01). Analyses of direct medical and intervention costs showed no cost savings associated with the intervention. For all patients and considering all-cause medical care, the ICER was $146 870 per quality-adjusted life-year (QALY) gained, while for patients with NYHA class III/IV symptoms and patients with SHF, the ICERs were $67 784 and $95 721 per QALY gained, respectively. Costs per QALY gained were $101 120 for all patients, $72 501 for patients with SHF, and $41 348 for patients with NYHA class III/IV symptoms. CONCLUSIONS: The intervention was effective but costly to implement and did not reduce utilization. It may not be cost-effective in other broadly representative samples of patients. However, with program cost reductions and proper targeting, this program may produce life-span increases at costs that are less than $100 000 per QALY gained.
RCT Entities:
OBJECTIVE: To evaluate the cost-effectiveness of a telephonic disease management (DM) intervention in heart failure (HF). STUDY DESIGN: Randomized controlled trial of telephonic DM among 1069 community-dwelling patients with systolic HF (SHF) and diastolic HF performed between 1999 and 2003. The enrollment period was 18 months per subject. METHODS: Bootstrap-resampled incremental cost-effectiveness ratios (ICERs) were computed and compared across groups. Direct medical costs were obtained from a medical record review that collected records from 92% of patients; 66% of records requested were obtained. RESULTS: Disease management produced statistically significant survival advantages among all patients (17.4 days, P = .04), among patients with New York Heart Association (NYHA) class III/IV symptoms (47.7 days, P = .02), and among patients with SHF (24.2 days, P = .01). Analyses of direct medical and intervention costs showed no cost savings associated with the intervention. For all patients and considering all-cause medical care, the ICER was $146 870 per quality-adjusted life-year (QALY) gained, while for patients with NYHA class III/IV symptoms and patients with SHF, the ICERs were $67 784 and $95 721 per QALY gained, respectively. Costs per QALY gained were $101 120 for all patients, $72 501 for patients with SHF, and $41 348 for patients with NYHA class III/IV symptoms. CONCLUSIONS: The intervention was effective but costly to implement and did not reduce utilization. It may not be cost-effective in other broadly representative samples of patients. However, with program cost reductions and proper targeting, this program may produce life-span increases at costs that are less than $100 000 per QALY gained.
Authors: Shelby D Reed; Yanhong Li; Shital Kamble; Daniel Polsky; Felicia L Graham; Margaret T Bowers; Gregory P Samsa; Sara Paul; Kevin A Schulman; David J Whellan; Barbara J Riegel Journal: Circ Cardiovasc Qual Outcomes Date: 2011-12-06
Authors: Robb D Kociol; John R Horton; Gregg C Fonarow; Eric M Reyes; Linda K Shaw; Christopher M O'Connor; G Michael Felker; Adrian F Hernandez Journal: Circ Heart Fail Date: 2011-07-08 Impact factor: 8.790
Authors: Melissa A Greiner; Bradley G Hammill; Gregg C Fonarow; David J Whellan; Zubin J Eapen; Adrian F Hernandez; Lesley H Curtis Journal: Am J Cardiol Date: 2011-12-10 Impact factor: 2.778
Authors: Rashid L Bashshur; Gary W Shannon; Brian R Smith; Dale C Alverson; Nina Antoniotti; William G Barsan; Noura Bashshur; Edward M Brown; Molly J Coye; Charles R Doarn; Stewart Ferguson; Jim Grigsby; Elizabeth A Krupinski; Joseph C Kvedar; Jonathan Linkous; Ronald C Merrell; Thomas Nesbitt; Ronald Poropatich; Karen S Rheuban; Jay H Sanders; Andrew R Watson; Ronald S Weinstein; Peter Yellowlees Journal: Telemed J E Health Date: 2014-06-26 Impact factor: 3.536
Authors: Paul L Hebert; Jane E Sisk; Jason J Wang; Leah Tuzzio; Jodi M Casabianca; Mark R Chassin; Carol Horowitz; Mary Ann McLaughlin Journal: Ann Intern Med Date: 2008-10-21 Impact factor: 25.391
Authors: Yanhong Li; Wayne C Levy; Matthew P Neilson; Stephen J Ellis; David J Whellan; Kevin A Schulman; Christopher M O'Connor; Shelby D Reed Journal: J Card Fail Date: 2014-06-02 Impact factor: 5.712