Deddo Moertl1, Sabine Steiner, Doug Coyle, Rudolf Berger. 1. Department of Internal Medicine III (Cardiology and Emergency Medicine), Landesklinikum St. Poelten, St. Poelten, Austria. deddo.moertl@stpoelten.lknoe.at
Abstract
OBJECTIVES: A recent randomized, controlled trial in chronic heart failure patients showed that NT-proBNP-guided, intensive patient management (BMC) on top of multidisciplinary care reduced all-cause mortality and heart failure hospitalizations compared with multidisciplinary care (MC) or usual care (UC). We now performed a cost-utility analysis of these interventions from a payer's perspective. METHODS:Costs related to hospitalizations, ambulatory physician and nurse visits, and NT-proBNP testing for the three management strategies were acquired for both Austria (€) and Canada ($) and combined with the survival and quality of life data from the clinical trial for cost-effectiveness analysis. Data on long-term survival, costs, and quality-adjusted life-years (QALY) were extrapolated for a 20-year time horizon using a Markov model, which simulated the progression of disease through beta-blocker use, hospitalizations, and mortality. RESULTS: BMC was the most cost-effective strategy as it was dominant (cost-saving with improved health outcome) over both MC and UC based on both Austrian and Canadian costs. Incremental cost-effectiveness ratios for MC relative to UC were €3,746 and $5,554 per QALY gained for Austrian and Canadian costs, respectively. The probabilities for BMC being the most cost-effective strategy were 92 percent at a threshold value of Austrian €40,000 and 93 percent at a threshold value of Canadian $50,000. CONCLUSIONS: NT-proBNP-guided, intensive HF patient management in addition to multidisciplinary care not only reduces death and hospitalization but also proves to be cost-effective.
RCT Entities:
OBJECTIVES: A recent randomized, controlled trial in chronic heart failurepatients showed that NT-proBNP-guided, intensive patient management (BMC) on top of multidisciplinary care reduced all-cause mortality and heart failure hospitalizations compared with multidisciplinary care (MC) or usual care (UC). We now performed a cost-utility analysis of these interventions from a payer's perspective. METHODS: Costs related to hospitalizations, ambulatory physician and nurse visits, and NT-proBNP testing for the three management strategies were acquired for both Austria (€) and Canada ($) and combined with the survival and quality of life data from the clinical trial for cost-effectiveness analysis. Data on long-term survival, costs, and quality-adjusted life-years (QALY) were extrapolated for a 20-year time horizon using a Markov model, which simulated the progression of disease through beta-blocker use, hospitalizations, and mortality. RESULTS:BMC was the most cost-effective strategy as it was dominant (cost-saving with improved health outcome) over both MC and UC based on both Austrian and Canadian costs. Incremental cost-effectiveness ratios for MC relative to UC were €3,746 and $5,554 per QALY gained for Austrian and Canadian costs, respectively. The probabilities for BMC being the most cost-effective strategy were 92 percent at a threshold value of Austrian €40,000 and 93 percent at a threshold value of Canadian $50,000. CONCLUSIONS: NT-proBNP-guided, intensive HF patient management in addition to multidisciplinary care not only reduces death and hospitalization but also proves to be cost-effective.
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
Authors: Syed Mohiuddin; Barnaby Reeves; Maria Pufulete; Rachel Maishman; Mark Dayer; John Macleod; Theresa McDonagh; Sarah Purdy; Chris Rogers; William Hollingworth Journal: BMJ Open Date: 2016-12-28 Impact factor: 2.692
Authors: Deddo Moertl; Johann Altenberger; Norbert Bauer; Robert Berent; Rudolf Berger; Armin Boehmer; Christian Ebner; Margarethe Fritsch; Friedrich Geyrhofer; Martin Huelsmann; Gerhard Poelzl; Thomas Stefenelli Journal: Wien Klin Wochenschr Date: 2017-10-27 Impact factor: 1.704