Document Detail

Heart failure disease management programs: a cost-effectiveness analysis.
MedLine Citation:
PMID:  18215605     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Heart failure (HF) disease management programs have shown impressive reductions in hospitalizations and mortality, but in studies limited to short time frames and high-risk patient populations. Current guidelines thus only recommend disease management targeted to high-risk patients with HF. METHODS: This study applied a new technique to infer the degree to which clinical trials have targeted patients by risk based on observed rates of hospitalization and death. A Markov model was used to assess the incremental life expectancy and cost of providing disease management for high-risk to low-risk patients. Sensitivity analyses of various long-term scenarios and of reduced effectiveness in low-risk patients were also considered. RESULTS: The incremental cost-effectiveness ratio of extending coverage to all patients was $9700 per life-year gained in the base case. In aggregate, universal coverage almost quadrupled life-years saved as compared to coverage of only the highest quintile of risk. A worst case analysis with simultaneous conservative assumptions yielded an incremental cost-effectiveness ratio of $110,000 per life-year gained. In a probabilistic sensitivity analysis, 99.74% of possible incremental cost-effectiveness ratios were <$50,000 per life-year gained. CONCLUSIONS: Heart failure disease management programs are likely cost-effective in the long-term along the whole spectrum of patient risk. Health gains could be extended by enrolling a broader group of patients with HF in disease management.
David C Chan; Paul A Heidenreich; Milton C Weinstein; Gregg C Fonarow
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Publication Detail:
Type:  Journal Article     Date:  2007-11-19
Journal Detail:
Title:  American heart journal     Volume:  155     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-24     Completed Date:  2008-02-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  332-8     Citation Subset:  AIM; IM    
Brigham and Women's Hospital, Boston, MA 02115, USA.
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MeSH Terms
Cost-Benefit Analysis
Disease Management*
Heart Failure / economics*,  therapy*
Markov Chains

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

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