title: Decision-analytic evaluation of the clinical effectiveness and cost-effectiveness of management programmes in chronic heart failure.
abstract: OBJECTIVE
  While management programmes (MPs) for chronic heart failure (CHF) are clinically effective, their cost-effectiveness remains uncertain. Thus, this study sought to determine the cost-effectiveness of MPs.
  
  
  RESULTS
  We developed a Markov model to estimate life expectancy, quality-adjusted life expectancy, lifetime costs, and the incremental cost-effectiveness of MPs as compared to standard care. Standard care was defined by the EuroHeart Failure Survey for Germany, MP efficacy was derived from our recent meta-analysis and cost estimates were based on the German healthcare system. For a population with a mean age 67 years (35% female) at onset of CHF, our model predicted an average quality-adjusted life expectancy of 2.64 years for standard care and 2.83 years for MP. MP yielded additional lifetime costs of euro1700 resulting in an incremental cost-utility ratio (ICUR) of euro8900 (95% CI: dominant to 177,100) per quality-adjusted life year (QALY) gained. Sensitivity analyses demonstrated that the ICUR was sensitive to age and sex.
  
  
  CONCLUSIONS
  MPs increase life expectancy in patients with CHF by an average of 84 days and increase lifetime cost of care by approximately euro1700. MPs improve outcomes in a cost-effective manner, although they are not cost-saving on a lifetime horizon.
authors.affiliation: Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-4724, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Göhler
authors.forename: Annette
authors.initials: A
authors.lastname: Conrads-Frank
authors.forename: Stewart S
authors.initials: SS
authors.lastname: Worrell
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Geisler
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.forename: Rainer
authors.initials: R
authors.lastname: Dietz
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert