title: Comparison of Ambulatory, High-Dose, Intravenous Diuretic Therapy to Standard Hospitalization and Diuretic Therapy for Treatment of Acute Decompensated Heart Failure.
abstract: Innovative treatment strategies for decompensated heart failure (HF) are required to achieve cost savings and improvements in outcomes. We developed a decision analytic model from a hospital perspective to compare 2 strategies for the treatment of decompensated HF, ambulatory diuretic infusion therapy, and hospitalization (standard care), with respect to total HF hospitalizations and costs. The ambulatory diuretic therapy strategy included outpatient treatment with high doses of intravenous loop diuretics in a specialized HF unit whereas standard care included hospitalization for intravenous loop diuretic therapy. Model probabilities were derived from the outcomes of patients who were treated for decompensated HF at Brigham and Women's Hospital (Boston, MA). Costs were based on Centers for Medicare and Medicaid reimbursement and the available reports. Based on a sample of patients treated at our institution, the ambulatory diuretic therapy strategy was estimated to achieve a significant reduction in total HF hospitalizations compared with standard care (relative reduction 58.3%). Under the base case assumptions, the total cost of the ambulatory diuretic therapy strategy was $6,078 per decompensation episode per 90 days compared with $12,175 per 90 days with standard care, for a savings of $6,097. The cost savings associated with the ambulatory diuretic strategy were robust against variation up to 50% in costs of ambulatory diuretic therapy and the likelihood of posttreatment hospitalization. An exploratory analysis suggests that ambulatory diuretic therapy is likely to remain cost saving over the long-term. In conclusion, this decision analytic model demonstrates that ambulatory diuretic therapy is likely to be cost saving compared with hospitalization for the treatment of decompensated HF from a hospital perspective. These results suggest that implementation of outpatient HF units that provide ambulatory diuretic therapy to well-selected subgroup of patients may result in significant reductions in health care costs while improving the care of patients across a variety of health care settings.
authors: Department of Pharmacy Services, Brigham and Women's Hospital, Massachusetts. Electronic address: LBuckley2@vcu.edu.
authors: Leo F
authors: LF
authors: Buckley
authors: International Center for Pharmaceutical Economics and Policy, MCPHS University, Massachusetts.
authors: Enrique
authors: E
authors: Seoane-Vazquez
authors: Department of Pharmacy Practice, MCPHS University, Massachusetts.
authors: Judy W M
authors: JW
authors: Cheng
authors: Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Massachusetts.
authors: Ahmed
authors: A
authors: Aldemerdash
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Massachusetts.
authors: Irene M
authors: IM
authors: Cooper
authors: Department of Pharmacy Services, Brigham and Women's Hospital, Massachusetts.
authors: Lina
authors: L
authors: Matta
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Massachusetts.
authors: Danika S
authors: DS
authors: Medina
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Massachusetts.
authors: Mandeep R
authors: MR
authors: Mehra
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Massachusetts.
authors: Kristina
authors: K
authors: Navarro-Velez
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Massachusetts.
authors: Elaine L
authors: EL
authors: Shea
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Massachusetts.
authors: Joanne R
authors: JR
authors: Weintraub
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Massachusetts.
authors: Lynne W
authors: LW
authors: Stevenson
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Massachusetts.
authors: Akshay S
authors: AS
authors: Desai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics; D001900:Boston; D003663:Decision Trees; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors