Cost-effectiveness of telephonic disease management in heart failure.
OBJECTIVE
To evaluate the cost-effectiveness of a telephonic disease management (DM) intervention in heart failure (HF).


METHODS
Randomized controlled trial of telephonic DM among 1069 community-dwelling patients with systolic HF (SHF) and diastolic HF performed between 1999 and 2003. The enrollment period was 18 months per subject.


METHODS
Bootstrap-resampled incremental cost-effectiveness ratios (ICERs) were computed and compared across groups. Direct medical costs were obtained from a medical record review that collected records from 92% of patients; 66% of records requested were obtained.


RESULTS
Disease management produced statistically significant survival advantages among all patients (17.4 days, P = .04), among patients with New York Heart Association (NYHA) class III/IV symptoms (47.7 days, P = .02), and among patients with SHF (24.2 days, P = .01). Analyses of direct medical and intervention costs showed no cost savings associated with the intervention. For all patients and considering all-cause medical care, the ICER was $146 870 per quality-adjusted life-year (QALY) gained, while for patients with NYHA class III/IV symptoms and patients with SHF, the ICERs were $67 784 and $95 721 per QALY gained, respectively. Costs per QALY gained were $101 120 for all patients, $72 501 for patients with SHF, and $41 348 for patients with NYHA class III/IV symptoms.


CONCLUSIONS
The intervention was effective but costly to implement and did not reduce utilization. It may not be cost-effective in other broadly representative samples of patients. However, with program cost reductions and proper targeting, this program may produce life-span increases at costs that are less than $100 000 per QALY gained.
Smith
Brad
B
Altarum Institute, 3737 Broadway, Ste 205, San Antonio, TX 78209, USA. brad.smith@altarum.org
Hughes-Cromwick
Paul F
PF
Forkner
Emma
E
Galbreath
Autumn Dawn
AD
D000368:Aged; D003362:Cost-Benefit Analysis; D003971:Diastole; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000401:mortality; D006801:Humans; D008297:Male; D015397:Program Evaluation / Q000191:economics; D011446:Prospective Studies; D019114:Remote Consultation; D013599:Systole; D013689:Telephone