title: Cost-Effectiveness of a Home Based Intervention for Secondary Prevention of Readmission with Chronic Heart Disease.
abstract: The aim of this study is to consider the cost-effectiveness of a nurse-led, home-based intervention (HBI) in cardiac patients with private health insurance compared to usual post-discharge care. A within trial analysis of the Young @ Heart multicentre, randomized controlled trial along with a micro-simulation decision analytical model was conducted to estimate the incremental costs and quality adjusted life years associated with the home based intervention compared to usual care. For the micro-simulation model, future costs, from the perspective of the funder, and effects are estimated over a twenty-year time horizon. An Incremental Cost-Effectiveness Ratio, along with Incremental Net Monetary Benefit, is evaluated using a willingness to pay threshold of $50,000 per quality adjusted life year. Sub-group analyses are conducted for men and women across three age groups separately. Costs and benefits that arise in the future are discounted at five percent per annum. Overall, home based intervention for secondary prevention in patients with chronic heart disease identified in the Australian private health care sector is not cost-effective. The estimated within trial incremental net monetary benefit is -$3,116 [95% CI: -11,145, $4,914]; indicating that the costs outweigh the benefits. However, for males and in particular males aged 75 years and above, home based intervention indicated a potential to reduce health care costs when compared to usual care (within trial: -$10,416 [95% CI: -$26,745, $5,913]; modelled analysis: -$1,980 [95% CI: -$22,843, $14,863]). This work provides a crucial impetus for future research to understand for whom disease management programs are likely to benefit most.
authors.affiliation: Centre for Applied Health Economics, Griffith University, Meadowbrook, Australia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Byrnes
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
authors.forename: Melinda
authors.initials: M
authors.lastname: Carrington
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
authors.forename: Yih-Kai
authors.initials: YK
authors.lastname: Chan
authors.affiliation: Bupa Australia, Melbourne, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Pollicino
authors.affiliation: Bupa Australia, Melbourne, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Dubrowin
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.affiliation: Centre for Applied Health Economics, Griffith University, Meadowbrook, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scuffham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D005260:Female; D006331:Heart Diseases / Q000191:economics* / Q000628:therapy; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention / Q000191:economics* / Q000379:methods