Abstract 2742: Ten-Year Follow-Up of a Nurse-Led, Multidisciplinary, Home-Based Intervention in Typically Old and Fragile Patients: Cost-Benefits and Outcomes
BACKGROUND: The medium-term benefits of nurse-led, multidisciplinary home-based interventions (HBI) in chronic heart failure (CHF) are now well documented. However, their cost-effectiveness over the longer-term, considering their ability to prolong survival, and the subsequent increased risk, therefore, of surviving CHF patients requiring recurrent hospitalisations before an inevitable death, is unknown.
METHODS: The long-term effects of a nurse-led multidisciplinary HBI in a typically old and fragile cohort of CHF patients discharged home from acute hospital care randomly allocated to HBI (n = 149) or usual post-discharge care (UC: n = 148) were studied up to 10 years (minimum 7.5 years) following index admission. All-cause mortality, event-free survival (readmission or death) and recurrent hospitalisation data were collected for this entire period. These data were then used to calculate the long-term cost-effectiveness of HBI (expressed as the cost per life-year saved).
RESULTS: During this prolonged follow-up, median survival in the HBI cohort was almost twice that of UC (40 vs. 22 months, p<0.001), with fewer deaths overall (HBI-77% vs. 89%; adjusted RR 0.74, 95% CI 0.53 to 0.80; p<0.001). HBI was associated with prolonged event-free survival (median 4 vs. 7 event-free months, p<0.01). Given this prolonged survival (30 more patients lived beyond 5 years), HBI patients accumulated more unplanned readmissions (560 vs. 550), but took 7 years to overtake UC. However, on an adjusted basis, both the rate of readmission and hospital stay was significantly lower in the HBI group (2.04±3.23 vs. 3.66±7.62 admissions p<0.05; 14.8±23.0 vs. 28.4±3.4 days/patient/year p<0.05). Overall, HBI was associated with 120 more life-years per 100 patients treated compared to UC (405 vs. 285 years) at a cost of $AU1,729 ($US1,308) per additional life-year gained when accounting for the cost of all hospital activity and applying the HBI.
CONCLUSION: In altering the natural history of CHF relative to UC (via prolonged survival and reduced frequency of recurrent hospitalisation), HBI is a remarkably cost and time-effective strategy over the longer-term.