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. 2018 Aug;9(4):523-532.
doi: 10.1007/s41999-018-0074-y. Epub 2018 Jun 6.

Cost-effectiveness of a follow-up program for older patients with heart failure: a randomized controlled trial

José L González-Guerrero  1 , Miguel A Hernández-Mocholi  2 , José M Ribera-Casado  3 , Nieves García-Mayolín  4 , Teresa Alonso-Fernández  5 , Narcís Gusi  6
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Cost-effectiveness of a follow-up program for older patients with heart failure: a randomized controlled trial

José L González-Guerrero et al. Eur Geriatr Med. 2018 Aug.

Abstract

Purpose: To assess the cost-utility of adding a disease management program (DMP) delivered by geriatric day hospital (GDH) for older patients with heart failure (HF) after hospital discharge.

Methods: 117 older HF patients discharged by a geriatric service were randomly assigned to DMP (n = 59) and usual care (UC) (n = 58) groups. The DMP group received health education, therapeutic control and monitoring through both telephone contacts and face-to-face visits at the GDH for 12 months. The UC group received standard health care. The main outcome measures were the costs from the health-care system and societal perspectives and quality-adjusted life-years (QALYs) using EuroQol (EQ-5D-3L). The cost-effectiveness analysis used the package ICEinfer in R 2.13.0.

Results: The mean age was 85 years, and 73% of the patients were women. The mean values of QALYs after 12 months were - 0.083 in DMP and - 0.154 in UC. Each extra QALY gained by the DMP relative to usual care cost was €38,274 and €25,390 from health-care or societal perspective, respectively. An investment of €44,000/QALY (Spanish Health System Threshold) showed a 91 and 85% of probability to be cost-effective from health-care and societal perspectives.

Conclusion: The intervention was moderately cost-effective in delaying deaths and preserving the loss of health-related quality of life in older patients with HF. The study was internationally registered with the ISRCTN10823032.

Keywords: Cost-effectiveness; Disease management programs; Elderly patients; Heart failure.

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