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Long-Term Cost-Effectiveness of Disease Management in Systolic Heart Failure

Author

Listed:
  • George Miller

    (Altarum Institute, Ann Arbor, MI, george.miller@altarum.org)

  • Stephen Randolph

    (Altarum Institute, San Antonio, TX)

  • Emma Forkner

    (South Carolina Department of Health and Human Services, Columbia)

  • Brad Smith

    (Altarum Institute, San Antonio, TX)

  • Autumn Dawn Galbreath

    (University of Texas Health Science Center at San Antonio, San Antonio)

Abstract

Background. Although congestive heart failure (CHF) is a primary target for disease management programs, previous studies have generated mixed results regarding the effectiveness and cost savings of disease management when applied to CHF. Objective. We estimated the long-term impact of systolic heart failure disease management from the results of an 18-month clinical trial. Methods. We used data generated from the trial (starting population distributions, resource utilization, mortality rates, and transition probabilities) in a Markov model to project results of continuing the disease management program for the patients' lifetimes. Outputs included distribution of illness severity, mortality, resource consumption, and the cost of resources consumed. Both cost and effectiveness were discounted at a rate of 3% per year. Cost-effectiveness was computed as cost per quality-adjusted life year (QALY) gained. Results. Model results were validated against trial data and indicated that, over their lifetimes, patients experienced a lifespan extension of 51 days. Combined discounted lifetime program and medical costs were $4850 higher in the disease management group than the control group, but the program had a favorable long-term discounted cost-effectiveness of $43,650/QALY. These results are robust to assumptions regarding mortality rates, the impact of aging on the cost of care, the discount rate, utility values, and the targeted population. Conclusions. Estimation of the clinical benefits and financial burden of disease management can be enhanced by model-based analyses to project costs and effectiveness. Our results suggest that disease management of heart failure patients can be cost-effective over the long term.

Suggested Citation

  • George Miller & Stephen Randolph & Emma Forkner & Brad Smith & Autumn Dawn Galbreath, 2009. "Long-Term Cost-Effectiveness of Disease Management in Systolic Heart Failure," Medical Decision Making, , vol. 29(3), pages 325-333, May.
    • Handle: RePEc:sae:medema:v:29:y:2009:i:3:p:325-333
    DOI: 10.1177/0272989X08327494
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    Citations

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    Cited by:

    1. F. Tomini & F. Prinzen & A. D. I. Asselt, 2016. "A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(9), pages 1159-1172, December.
    2. Qi Cao & Erik Buskens & Hans L. Hillege & Tiny Jaarsma & Maarten Postma & Douwe Postmus, 2019. "Stratified treatment recommendation or one-size-fits-all? A health economic insight based on graphical exploration," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 475-482, April.
    3. de Bruin, Simone R. & Heijink, Richard & Lemmens, Lidwien C. & Struijs, Jeroen N. & Baan, Caroline A., 2011. "Impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or chronic obstructive pulmonary disease: A systematic review of the literature," Health Policy, Elsevier, vol. 101(2), pages 105-121, July.

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