| Heart failure disease management programs: a cost-effectiveness analysis. | |
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MedLine Citation:
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PMID: 18215605 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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David C Chan; Paul A Heidenreich; Milton C Weinstein; Gregg C Fonarow |
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Publication Detail:
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Type: Journal Article Date: 2007-11-19 |
Journal Detail:
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Title: American heart journal Volume: 155 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2008 Feb |
Date Detail:
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Created Date: 2008-01-24 Completed Date: 2008-02-15 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 332-8 Citation Subset: AIM; IM |
Affiliation:
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Brigham and Women's Hospital, Boston, MA 02115, USA. dcchan@partners.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Cost-Benefit Analysis Disease Management* Heart Failure / economics*, therapy* Humans Markov Chains |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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