title: A cost-effectiveness study of person-centered integrated heart failure and palliative home care: Based on a randomized controlled trial.
abstract: BACKGROUND
  Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care.
  
  
  METHODS
  A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients' responses to the EQ-5D quality of life instrument.
  
  
  METHODS
  Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital.
  
  
  RESULTS
  EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs.
  
  
  CONCLUSIONS
  The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden The Arctic Research Centre, Umeå University, Umeå, Sweden klasse.sahlen@umu.se.
authors.forename: Klas-Göran
authors.initials: KG
authors.lastname: Sahlen
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden Research Unit, Department of Medicine, Umeå University, Skellefteå, Sweden.
authors.forename: Kurt
authors.initials: K
authors.lastname: Boman
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden The Arctic Research Centre, Umeå University, Umeå, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Brännström
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000592:standards; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000628:therapy*; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D009629:Person-Centered Psychotherapy / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013548:Sweden
keywords: Cost-effectiveness; heart failure; home care