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Randomized Controlled Trial
. 2015 Dec 10;10(12):e0144545.
doi: 10.1371/journal.pone.0144545. eCollection 2015.

Cost-Effectiveness of a Home Based Intervention for Secondary Prevention of Readmission with Chronic Heart Disease

Joshua Byrnes  1 , Melinda Carrington  2 , Yih-Kai Chan  2 , Christine Pollicino  3 , Natalie Dubrowin  3 , Simon Stewart  2 , Paul A Scuffham  1
Affiliations
Randomized Controlled Trial

Cost-Effectiveness of a Home Based Intervention for Secondary Prevention of Readmission with Chronic Heart Disease

Joshua Byrnes et al. PLoS One. .

Abstract

The aim of this study is to consider the cost-effectiveness of a nurse-led, home-based intervention (HBI) in cardiac patients with private health insurance compared to usual post-discharge care. A within trial analysis of the Young @ Heart multicentre, randomized controlled trial along with a micro-simulation decision analytical model was conducted to estimate the incremental costs and quality adjusted life years associated with the home based intervention compared to usual care. For the micro-simulation model, future costs, from the perspective of the funder, and effects are estimated over a twenty-year time horizon. An Incremental Cost-Effectiveness Ratio, along with Incremental Net Monetary Benefit, is evaluated using a willingness to pay threshold of $50,000 per quality adjusted life year. Sub-group analyses are conducted for men and women across three age groups separately. Costs and benefits that arise in the future are discounted at five percent per annum. Overall, home based intervention for secondary prevention in patients with chronic heart disease identified in the Australian private health care sector is not cost-effective. The estimated within trial incremental net monetary benefit is -$3,116 [95% CI: -11,145, $4,914]; indicating that the costs outweigh the benefits. However, for males and in particular males aged 75 years and above, home based intervention indicated a potential to reduce health care costs when compared to usual care (within trial: -$10,416 [95% CI: -$26,745, $5,913]; modelled analysis: -$1,980 [95% CI: -$22,843, $14,863]). This work provides a crucial impetus for future research to understand for whom disease management programs are likely to benefit most.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and the authors of this manuscript have the following competing interests: The Young@Heart trial was funded by Bupa Australia. JB, PS, SS, YKC and MC have provided paid consultancy for Bupa Australia; CP and ND work for Bupa Australia. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Overview of Model Structure.
CVD: cardiovascular disease
Fig 2
Fig 2. Probabilistic Sensitivity Analysis for Cost-effectiveness of Home Based Intervention vs. Usual Care.
Each dot represents a modelled incremental cost-effectiveness ratio; the eclipse represents the 95% credible interval; the dashed line represents cost-effectiveness ratio equal to $50,000 per quality adjusted life year. HBI: home based intervention. WTP: willingness to pay threshold. Incremental Effectiveness measured in Quality Adjusted Life Years, Incremental Cost measured in Australian Dollars (2013)
See this image and copyright information in PMC

References

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