title: Hospital cost effect of a heart failure disease management program: the Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) trial.
abstract: BACKGROUND
  Determine the effect on hospitalization cost of a heart failure disease management (HFDM) program delivered within a diverse provider network as demonstrated in the SPAN-CHF randomized controlled trial.
  
  
  METHODS
  The SPAN-CHF trial was a prospective randomized assessment of the effectiveness of HFDM delivered for 90 days across a diverse provider network in a heterogeneous population of 200 patients. Baseline clinical and demographic data were obtained on each patient, mortality was monitored, and hospitalizations were tracked for 90 days. Cost estimates for each hospitalization were based on a subsample of patients seen at Tufts-New England Medical Center for whom hospitalization costs were calculated. Heart failure disease management program costs were estimated using a programmatic budget model. Hospital utilization and cost data were combined to estimate medical costs for intervention and control groups.
  
  
  RESULTS
  Heart failure disease management had a favorable effect on heart failure hospitalization, which was partially offset by noncardiac hospitalizations. The relative odds of at least one all-cause hospitalization during the intervention period trended less for the intervention group compared with the control group (0.76 [95% CI 0.38-1.51]). The point estimate of the differential hospitalization cost between control and intervention groups was a reduction in cost of $375 per patient. The net effect including the costs of the program was an increase of $488 per patient for the intervention group compared with the control group. The program would have been cost saving if HFDM costs had been 24% lower.
  
  
  CONCLUSIONS
  The HFDM intervention, administered over 90 days to patients hospitalized for heart failure, succeeded in reducing the rate of heart failure hospitalizations, although this effect was partially offset by an increase in non-heart failure hospitalizations. The resulting modest reduction in all-cause hospitalization costs was exceeded by the cost of the intervention. Thus, although the reduction in heart failure may be interpreted as an improvement in health status, it could not be considered cost saving.
authors.affiliation: Cardiovascular Clinical Studies, Boston, MA 02111, USA. dgregory@ccstrials.com
authors.forename: Douglas
authors.initials: D
authors.lastname: Gregory
authors.forename: Carey
authors.initials: C
authors.lastname: Kimmelstiel
authors.forename: Kathleen
authors.initials: K
authors.lastname: Perry
authors.forename: Amay
authors.initials: A
authors.lastname: Parikh
authors.forename: Varda
authors.initials: V
authors.lastname: Konstam
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Konstam
mesh_terms: D002303:Cardiac Output, Low / Q000191:economics* / Q000451:nursing* / Q000628:therapy; D002309:Cardiology / Q000379:methods; D003363:Cost Control; D006333:Heart Failure / Q000191:economics* / Q000451:nursing* / Q000628:therapy; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010348:Patient Care Team; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D012648:Self Care