Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort — The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care)

Shoko Maru; Joshua Byrnes; Melinda J. Carrington; Yih Kai Chan; David R. Thompson; Simon Stewart; Paul A. Scuffham

doi:10.1016/j.ijcard.2015.08.066

Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort — The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care)

Shoko Maru^*, Joshua Byrnes, Melinda J. Carrington, Yih Kai Chan, David R. Thompson, Simon Stewart, Paul A. Scuffham

^*Corresponding author for this work

School of Nursing and Midwifery

Research output: Contribution to journal › Article › peer-review

48 Citations (Scopus)

Abstract

Objective: To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics.

Methods: A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost-utility ratios were computed based on quality-adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB.

Results: During median follow-up of 3.2 years, HBI was associated with slightly higher QALYs (+ 0.26 years per person; p = 0.078) and lower total healthcare costs (AU$ -13,100 per person; p = 0.025) mainly driven by significantly reduced duration of all-cause hospital stay (-10 days; p = 0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions < 1 year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia.

Conclusions: Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity.

Original language	English
Pages (from-to)	368-375
Number of pages	8
Journal	International Journal of Cardiology
Volume	201
Early online date	24 Aug 2015
DOIs	https://doi.org/10.1016/j.ijcard.2015.08.066
Publication status	Published - Dec 2015

Bibliographical note

Funding Information:
This work was supported by a National Health and Medical Research Council of Australia program grant [grant 519823] and in part by the Victorian Government's Operational Infrastructure Support Program. MC and SS are supported by the National Health and Medical Research Council of Australia.

Publisher Copyright:
© 2015 Elsevier Ireland Ltd.

Keywords

Cost effectiveness
Disease management
Economic evaluation
Heart failure
Net monetary benefit

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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Maru, S., Byrnes, J., Carrington, M. J., Chan, Y. K., Thompson, D. R., Stewart, S., & Scuffham, P. A. (2015). Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort — The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care). International Journal of Cardiology, 201, 368-375. https://doi.org/10.1016/j.ijcard.2015.08.066

Maru, Shoko ; Byrnes, Joshua ; Carrington, Melinda J. et al. / Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort — The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care). In: International Journal of Cardiology. 2015 ; Vol. 201. pp. 368-375.

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title = "Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort — The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care)",

abstract = "Objective: To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics. Methods: A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost-utility ratios were computed based on quality-adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB. Results: During median follow-up of 3.2 years, HBI was associated with slightly higher QALYs (+ 0.26 years per person; p = 0.078) and lower total healthcare costs (AU$ -13,100 per person; p = 0.025) mainly driven by significantly reduced duration of all-cause hospital stay (-10 days; p = 0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions < 1 year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia. Conclusions: Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity.",

keywords = "Cost effectiveness, Disease management, Economic evaluation, Heart failure, Net monetary benefit",

author = "Shoko Maru and Joshua Byrnes and Carrington, {Melinda J.} and Chan, {Yih Kai} and Thompson, {David R.} and Simon Stewart and Scuffham, {Paul A.}",

note = "Funding Information: This work was supported by a National Health and Medical Research Council of Australia program grant [grant 519823] and in part by the Victorian Government's Operational Infrastructure Support Program. MC and SS are supported by the National Health and Medical Research Council of Australia. Publisher Copyright: {\textcopyright} 2015 Elsevier Ireland Ltd.",

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Maru, S, Byrnes, J, Carrington, MJ, Chan, YK, Thompson, DR, Stewart, S & Scuffham, PA 2015, 'Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort — The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care)', International Journal of Cardiology, vol. 201, pp. 368-375. https://doi.org/10.1016/j.ijcard.2015.08.066

Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort — The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care). / Maru, Shoko; Byrnes, Joshua; Carrington, Melinda J. et al.
In: International Journal of Cardiology, Vol. 201, 12.2015, p. 368-375.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort — The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care)

AU - Maru, Shoko

AU - Byrnes, Joshua

AU - Carrington, Melinda J.

AU - Chan, Yih Kai

AU - Thompson, David R.

AU - Stewart, Simon

AU - Scuffham, Paul A.

N1 - Funding Information: This work was supported by a National Health and Medical Research Council of Australia program grant [grant 519823] and in part by the Victorian Government's Operational Infrastructure Support Program. MC and SS are supported by the National Health and Medical Research Council of Australia. Publisher Copyright: © 2015 Elsevier Ireland Ltd.

PY - 2015/12

Y1 - 2015/12

N2 - Objective: To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics. Methods: A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost-utility ratios were computed based on quality-adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB. Results: During median follow-up of 3.2 years, HBI was associated with slightly higher QALYs (+ 0.26 years per person; p = 0.078) and lower total healthcare costs (AU$ -13,100 per person; p = 0.025) mainly driven by significantly reduced duration of all-cause hospital stay (-10 days; p = 0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions < 1 year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia. Conclusions: Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity.

AB - Objective: To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics. Methods: A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost-utility ratios were computed based on quality-adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB. Results: During median follow-up of 3.2 years, HBI was associated with slightly higher QALYs (+ 0.26 years per person; p = 0.078) and lower total healthcare costs (AU$ -13,100 per person; p = 0.025) mainly driven by significantly reduced duration of all-cause hospital stay (-10 days; p = 0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions < 1 year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia. Conclusions: Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity.

KW - Cost effectiveness

KW - Disease management

KW - Economic evaluation

KW - Heart failure

KW - Net monetary benefit

U2 - 10.1016/j.ijcard.2015.08.066

DO - 10.1016/j.ijcard.2015.08.066

M3 - Article

C2 - 26310979

AN - SCOPUS:84943518141

SN - 0167-5273

VL - 201

SP - 368

EP - 375

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Maru S, Byrnes J, Carrington MJ, Chan YK, Thompson DR, Stewart S et al. Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort — The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care). International Journal of Cardiology. 2015 Dec;201:368-375. Epub 2015 Aug 24. doi: 10.1016/j.ijcard.2015.08.066