title: Resource use and cost implications of implementing a heart failure program for patients with systolic heart failure in Swedish primary health care.
abstract: OBJECTIVE
  Heart failure (HF) is a common but serious condition which involves a significant economic burden on the health care economy. The purpose of this study was to evaluate cost and quality of life (QoL) implications of implementing a HF management program (HFMP) in primary health care (PHC).
  
  
  RESULTS
  This was a prospective randomized open-label study including 160 patients with a diagnosis of HF from five PHC centers in south-eastern Sweden. Patients randomized to the intervention group received information about HF from HF nurses and from a validated computer-based awareness program. HF nurses and physicians followed the patients intensely in order to optimize HF treatment according to current guidelines. The patients in the control group were followed by their regular general practitioner (GP) and received standard treatment according to local management routines. No significant changes were observed in NYHA class and quality-adjusted life years (QALY), implying that functional class and QoL were preserved. However, costs for hospital care (HC) and PHC were reduced by EUR 2167, or 33%. The total cost was EUR 4471 in the intervention group and EUR 6638 in the control group.
  
  
  CONCLUSIONS
  Introducing HFMP in Swedish PHC in patients with HF entails a significant reduction in resource utilization and costs, and maintains QoL. Based on these results, a broader implementation of HFMP in PHC may be recommended. However, results should be confirmed with extended follow-up to verify long-term effects.
authors.affiliation: Department of Medical and Health Sciences, Linkoping University, Department of Primary Health Care, Linkoping, County of Östergötland, Sweden. Electronic address: bjorn.agvall@lio.se.
authors.forename: Björn
authors.initials: B
authors.lastname: Agvall
authors.affiliation: Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Paulsson
authors.affiliation: Department of Medical and Health Sciences, Linkoping University, Department of Primary Health Care, Linkoping, County of Östergötland, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Foldevi
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Dahlström
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden.
authors.forename: Urban
authors.initials: U
authors.lastname: Alehagen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics*; D054143:Heart Failure, Systolic / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D011446:Prospective Studies; D013548:Sweden / Q000453:epidemiology
keywords: Health care cost; Heart failure; Heart failure management program; Primary health care; Resource utilization