Is multidisciplinary care of heart failure cost-beneficial when combined with optimal medical care?
BACKGROUND
Multidisciplinary care (MDC) of heart failure (HF) can significantly reduce rates of unplanned hospitalisation, the major cost component of HF care.


OBJECTIVE
This prospective, randomised, controlled study examines the cost-benefits of MDC of HF in the setting of optimal medical care.


METHODS
98 NYHA class IV HF patients (mean age 70.8+/-10.5 years) were randomised to MDC (n=51) or routine care (RC; n=47) of HF. A direct intervention cost was calculated from contact time (scheduled and unscheduled) spent by the MDC team. Unplanned hospitalisation costs for HF were calculated at a daily rate of 242. Outcomes were determined in monetary terms, i.e. the cost of the service per hospitalisation prevented and net costs/savings at 3 months.


RESULTS
The direct intervention cost of the MDC team was 5860, with an average cost per patient of 113 (95% Cl: 97-128). At 3 months, there were a total of 12 unplanned HF readmissions in the RC group (25.5% rate, 195 days) compared to 2 in the MDC group (3.9% rate, 17 days). The number needed to treat to prevent one hospitalisation for HF was 6 over 3 months. The cost of the service per hospitalisation prevented was 586. The intervention produced a net cost saving of 37,216 for 51 patients treated over 3 months. Sensitivity analyses using 50% variation in costs and lower relative risk reductions confirmed the cost-benefits of the intervention.


CONCLUSIONS
MDC of HF remains cost-beneficial when combined with optimal, medical care. The significant clinical and cost-benefits suggest that this intensive approach to MDC and medical management should become the standard of care for HF.
Ledwidge
Mark
M
Heart Failure Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Barry
Michael
M
Cahill
John
J
Ryan
Enda
E
Maurer
Brian
B
Ryder
Mary
M
Travers
Bronagh
B
Timmons
Lorna
L
McDonald
Ken
K
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis / Q000191:economics; D003657:Decision Making; D004077:Digoxin / Q000008:administration & dosage / Q000191:economics; D004232:Diuretics / Q000008:administration & dosage / Q000191:economics; D004305:Dose-Response Relationship, Drug; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000191:economics; D017048:Health Care Costs; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007494:Ireland; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000008:administration & dosage / Q000191:economics; D011446:Prospective Studies; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000191:economics / Q000628:therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D004077:Digoxin; D005665:Furosemide; D020913:Perindopril