Abstract 3272: Heart Failure Disease Management Strategies In Medicare Beneficiaries With Heart Failure Are Cost Effective
Introduction: Clinical trials of heart failure disease management (HFDM) programs have been shown to reduce readmission rates without significant increases in overall cost of care for older patients with heart failure (HF)
Hypothesis: We assessed the hypothesis that HFDM versus usual care for Medicare beneficiaries are cost effective.
Methods:We performed a cost-effectiveness analysis using a Markov decision analytic model to compare a variety of published HFDM programs versus usual care (UC). Medicare reimbursement data for year 2006 were used to derive estimates for cost of care. Outcomes data were taken from published randomized controlled trials available up to September 2006.HFDM programs were deconstructed and classified based on distinct differences in the components for outpatient care: single home visit (SHV), frequent telephone contact (FTC), increased clinic follow-up (ICF), and extended home care services (EHC). Analyses were conducted from a societal perspective with cost per quality adjusted life year (QALY) as the primary outcome measure.
Results:Base-case analyses showed that ICF, EHC and SHV strategies for HFDM had lower costs yet generated more QALYs than UC ie these strategies dominated UC. FTC had higher costs than UC but resulted in more QALYs with incremental cost-effectiveness ratio (ICER) of $16,810 per QALY. Univariate sensitivity analyses showed base case results were insensitive to all parameter variation except for total and readmission costs for ICF, EHC and FTC interventions. Acceptability curves drawn using Monte Carlo simulations showed that no intervention had 90% of simulations below ICER threshold of $50,000/QALY.
Conclusion:In conclusion, currently available disease management strategies are economically superior to usual care for Medicare beneficiaries with HF and should be adopted as the standard of care.