Cost-Effectiveness Benefits of a Disease Management Program: The REMADHE Trial Results

Edimar Alcides Bocchi*, Fatima das Dores da Cruz, Sara Michelly Brandao, Victor Issa, Silvia Moreira Ayub-Ferreira, Hans-Peter Brunner la Rocca, Sandra Sanders van Wijk

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

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 similar to 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 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.

Original languageEnglish
Pages (from-to)627-637
Number of pages11
JournalJournal of Cardiac Failure
Volume24
Issue number10
DOIs
Publication statusPublished - Oct 2018

Keywords

  • Heart failure
  • cost-effectiveness
  • disease management program
  • cost
  • CHRONIC HEART-FAILURE
  • ECONOMIC BURDEN
  • HEALTH-CARE
  • FOLLOW-UP
  • GUIDELINES
  • ADHERENCE
  • IMPACT
  • HF
  • CARDIOMYOPATHY
  • ELABORATION

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