BACKGROUND: Published studies have generated mixed, controversial results regarding the cost-effectiveness of heart failure disease management programs (HF-DMPs). This study assessed the cost-effectiveness of an HF-DMP in ambulatory patients compared with usual care (UC). METHODS: In the prospective randomized REMADHE trial, we evaluated incremental costs per quality-adjusted life-year (QALY) and life-year (LY) gained as effectiveness ratios (ICERs) over a study period of 2.47 ± 1.75 years. RESULTS: The REMADHE HF-DMP was more effective and less costly than UC in terms of both QALYs and LYs (95% and 55% chance of dominance, respectively). Average saving was US$7345 (2.5%-97.5% bootstrapped confidence interval -16,573 to +921). The chance of DMP being cost-effective at a willingness to pay US$10,000 per QALY or LY was 99% and 96%, respectively. Cost-effectiveness of HF-DMP was highest in subgroups with left ventricular ejection fraction <35%, age >50 years, male sex, New York Heart Association (NYHA) functional class ≥III, and ischemic etiology. The chance of DMP being cost-effective at a willingness to pay US$10,000 per QALY was ≥90% in all subgroups apart from NYHA functional class I-II, where it was 70%. Even when the intervention costs increased by 500% or when excluding outliers in costs, DMP had a high chance of being cost-effective (87%-99%). CONCLUSIONS: The HF-DMP of the REMADHE trial, which encompasses long-term repeated education alongside telephone monitoring, has a high probability of being cost-effective in ambulatory patients with HF.
RCT Entities:
BACKGROUND: Published studies have generated mixed, controversial results regarding the cost-effectiveness of heart failure disease management programs (HF-DMPs). This study assessed the cost-effectiveness of an HF-DMP in ambulatory patients compared with usual care (UC). METHODS: In the prospective randomized REMADHE trial, we evaluated incremental costs per quality-adjusted life-year (QALY) and life-year (LY) gained as effectiveness ratios (ICERs) over a study period of 2.47 ± 1.75 years. RESULTS: The REMADHE HF-DMP was more effective and less costly than UC in terms of both QALYs and LYs (95% and 55% chance of dominance, respectively). Average saving was US$7345 (2.5%-97.5% bootstrapped confidence interval -16,573 to +921). The chance of DMP being cost-effective at a willingness to pay US$10,000 per QALY or LY was 99% and 96%, respectively. Cost-effectiveness of HF-DMP was highest in subgroups with left ventricular ejection fraction <35%, age >50 years, male sex, New York Heart Association (NYHA) functional class ≥III, and ischemic etiology. The chance of DMP being cost-effective at a willingness to pay US$10,000 per QALY was ≥90% in all subgroups apart from NYHA functional class I-II, where it was 70%. Even when the intervention costs increased by 500% or when excluding outliers in costs, DMP had a high chance of being cost-effective (87%-99%). CONCLUSIONS: The HF-DMP of the REMADHE trial, which encompasses long-term repeated education alongside telephone monitoring, has a high probability of being cost-effective in ambulatory patients with HF.
Authors: Edimar Alcides Bocchi; Henrique Turin Moreira; Juliana Sanajotti Nakamuta; Marcus Vinicius Simões; Alberto de Almeida Las Casas; Altamiro Reis da Costa; Amberson Vieira de Assis; André Rodrigues Durães; Antonio Carlos Pereira-Barretto; Antonio Delduque de Araujo Ravessa; Ariane Vieira Scarlatelli Macedo; Bruno Biselli; Carolina Maria Nogueira Pinto; Conrado Roberto Hoffmann Filho; Costantino Roberto Costantini; Dirceu Rodrigues Almeida; Edval Gomes Dos Santos; Erwin Soliva Junior; Estevão Lanna Figueiredo; Felipe Neves de Albuquerque; Felipe Paulitsch; Fernando Carvalho Neuenschwander; José Albuquerque de Figueiredo Neto; Flavio de Souza Brito; Heno Ferreira Lopes; Humberto Villacorta; João David de Souza Neto; João Mariano Sepulveda; José Carlos Aidar Ayoub; José F Vilela-Martin; Juliano Novaes Cardoso; Laercio Uemura; Lidia Zytynski Moura; Lilia Nigro Maia; Lucia Brandão de Oliveira; Lucimir Maia; Luís Beck da Silva; Luís Henrique Wolff Gowdak; Luiz Claudio Danzmann; Marcus Andrade; Maria Christiane Valeria Braga Braile-Sternieri; Maria da Consolação Vieira Moreira; Olimpio R França Neto; Otavio Rizzi Coelho Filho; Paulo Frederico Esteves; Priscila Raupp-da-Rosa; Ricardo Jorge de Queiroz E Silva; Ricardo Mourilhe-Rocha; Ruy Felipe Melo Viégas; Salvador Rassi; Sandrigo Mangili; Sergio Emanuel Kaiser; Silvia Marinho Martins; Vitor Sergio Kawabata Journal: Clinics (Sao Paulo) Date: 2021-01-20 Impact factor: 2.365