title: Cost-effectiveness of specialized multidisciplinary heart failure clinics in Ontario, Canada.
abstract: BACKGROUND
  Specialized multidisciplinary clinics have been shown to reduce mortality in heart failure (HF). Our objective was to evaluate the cost-effectiveness of this model of care delivery.
  
  
  METHODS
  We performed a cost-effectiveness analysis, with a 12-year time horizon, from the perspective of the Ontario Ministry of Health and Long-term Care, comparing a standard care cohort, consisting of all patients admitted to hospital with HF in 2005, to a hypothetical cohort treated in HF clinics. Survival curves describing the natural history of HF were constructed using mortality estimates from the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. Survival benefits and resource uptake associated with HF clinics were estimated from a meta-analysis of published trials. HF clinics costs were obtained by costing a representative clinic in Ontario. Health-related costs were determined through linkage to administrative databases. Outcome measures included life expectancy (years), costs (in 2008 Canadian dollars) and the incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  HF clinics were associated with a 29% reduction in all-cause mortality (risk ratio [RR] 0.71; 95% confidence interval [CI] 0.56-0.91) but a 12% increase in hospitalizations (RR 1.12; 95% CI 0.92-1.135). The cost of care in HF clinics was $52 per 30 patient-days. Projected life-expectancy of HF clinic patients was 3.91 years, compared to 3.21 years for standard care. The 12-year cumulative cost per patient in the HF clinic group was $66,532 versus $53,638 in the standard care group. The ICER was $18,259/life-year gained.
  
  
  CONCLUSIONS
  HF clinics appear to be a cost effective way of delivering ambulatory care to HF patients.
authors.affiliation: Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. wijeysundera@gmail.com
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.forename: Márcio
authors.initials: M
authors.lastname: Machado
authors.forename: Xuesong
authors.initials: X
authors.lastname: Wang
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Van Der Velde
authors.forename: Nancy
authors.initials: N
authors.lastname: Sikich
authors.forename: William
authors.initials: W
authors.lastname: Witteman
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Robert
authors.initials: R
authors.lastname: Petrella
authors.forename: Martin
authors.initials: M
authors.lastname: O'Flaherty
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000191:economics* / Q000628:therapy; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D010348:Patient Care Team / Q000191:economics*