Document Detail


Cost-effectiveness of telephonic disease management in heart failure.
MedLine Citation:
PMID:  18269306     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the cost-effectiveness of a telephonic disease management (DM) intervention in heart failure (HF). STUDY DESIGN: Randomized controlled trial of telephonic DM among 1069 community-dwelling patients with systolic HF (SHF) and diastolic HF performed between 1999 and 2003. The enrollment period was 18 months per subject. METHODS: Bootstrap-resampled incremental cost-effectiveness ratios (ICERs) were computed and compared across groups. Direct medical costs were obtained from a medical record review that collected records from 92% of patients; 66% of records requested were obtained. RESULTS: Disease management produced statistically significant survival advantages among all patients (17.4 days, P = .04), among patients with New York Heart Association (NYHA) class III/IV symptoms (47.7 days, P = .02), and among patients with SHF (24.2 days, P = .01). Analyses of direct medical and intervention costs showed no cost savings associated with the intervention. For all patients and considering all-cause medical care, the ICER was $146 870 per quality-adjusted life-year (QALY) gained, while for patients with NYHA class III/IV symptoms and patients with SHF, the ICERs were $67 784 and $95 721 per QALY gained, respectively. Costs per QALY gained were $101 120 for all patients, $72 501 for patients with SHF, and $41 348 for patients with NYHA class III/IV symptoms. CONCLUSIONS: The intervention was effective but costly to implement and did not reduce utilization. It may not be cost-effective in other broadly representative samples of patients. However, with program cost reductions and proper targeting, this program may produce life-span increases at costs that are less than $100 000 per QALY gained.
Authors:
Brad Smith; Paul F Hughes-Cromwick; Emma Forkner; Autumn Dawn Galbreath
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The American journal of managed care     Volume:  14     ISSN:  1936-2692     ISO Abbreviation:  Am J Manag Care     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-13     Completed Date:  2008-03-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9613960     Medline TA:  Am J Manag Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  106-15     Citation Subset:  H    
Affiliation:
Altarum Institute, 3737 Broadway, Ste 205, San Antonio, TX 78209, USA. brad.smith@altarum.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Cost-Benefit Analysis
Diastole
Disease Management*
Female
Heart Failure / economics*,  mortality
Humans
Male
Program Evaluation / economics
Prospective Studies
Remote Consultation*
Systole
Telephone*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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