Heart failure disease management programs: a cost-effectiveness analysis.
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.
Chan
David C
DC
Brigham and Women's Hospital, Boston, MA 02115, USA. dcchan@partners.org
Heidenreich
Paul A
PA
Weinstein
Milton C
MC
Fonarow
Gregg C
GC
D003362:Cost-Benefit Analysis; D019468:Disease Management; D006333:Heart Failure / Q000191:economics* / Q000628:therapy*; D006801:Humans; D008390:Markov Chains