Abstract 12821: Home-Based Management for Chronic Heart Failure Reduces Recurrent Hospital Stay and Total Healthcare Costs Compared to a Clinic-Based Program: Results from the WHICH? Trial

Abstract

BACKGROUND: Hospitalization is the most costly component of healthcare for chronic heart failure (CHF). The Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) Trial compared the impact of two common forms of CHF management.

METHODS: This multi-centre randomized controlled trial (blinded endpoints) enrolled 280 hospitalized CHF patients (73% male, aged 71±14 years and 73% with LVEF≤45%) who were randomized to a home-based intervention (HBI) or specialized CHF clinic-based intervention (CBI). The primary endpoint was all-cause, unplanned recurrent hospitalization or death during 12-18month follow-up. Secondary endpoints included type/duration of recurrent hospitalization, costs of healthcare and quality-adjusted life years (QALYs). Direct components of healthcare (including hospitalizations, outpatient visits, community visits, drug therapy and program costs) were prospectively measured and multiplied using standardized costing units (US$1 ~ AU$1). QALYs were calculated from change in EQ5D health survey scores from baseline to 12 months in survivors (n=230).

RESULTS: The primary endpoint was not significantly different between groups (71% HBI vs. 76% CBI). However, HBI patients had fewer days of recurrent hospitalization (-35%; p=0.003). Specific program costs for HBI and CBI were similar (median [IQR]: $1827 [$1813-$1843] and $1823 [$1810-$1844]. Hospital costs accounted for most health expenditure in both HBI (81%) and CBI (87%) patients; with 13% and 8% more for ancillary/community care. Total healthcare costs ($3.93 vs. $5.53 million) were significantly less for HBI ($34 [$13-$81] vs. $41 [$13-$107] /patient/ day; p<0.05).There was no difference in baseline EQ5D for HBI vs. CBI (0.71±0.22 vs. 0.71±0.19, p=0.792). However, HBI was associated with a gain of 0.03 (95% CI -0.05 to 0.11) QALY relative to CBI.Consequently, HBI appeared more cost-effective ($34,792 vs. $57,420 per QALY) than CBI.

CONCLUSIONS: Head-to-head, HBI reduced recurrent hospital stay and was associated with significantly less total healthcare expenditure per QALY relative to CBI. These are potentially important differences when selecting which CHF management program to apply.