Decision-analytic evaluation of the clinical effectiveness and cost-effectiveness of management programmes in chronic heart failure.
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.
Göhler
Alexander
A
Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-4724, USA.
Conrads-Frank
Annette
A
Worrell
Stewart S
SS
Geisler
Benjamin P
BP
Halpern
Elkan F
EF
Dietz
Rainer
R
Anker
Stefan D
SD
Gazelle
G Scott
GS
Siebert
Uwe
U