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Cost-effectiveness of telephonic disease management in heart failure.
Am J Manag Care. 2008 Feb; 14(2):106-15.AJ

Abstract

OBJECTIVE

To evaluate the cost-effectiveness of a telephonic disease management (DM) intervention in heart failure (HF).

STUDY DESIGN

Randomized controlled trial of telephonic DM among 1069 community-dwelling patients with systolic HF (SHF) and diastolic HF performed between 1999 and 2003. The enrollment period was 18 months per subject.

METHODS

Bootstrap-resampled incremental cost-effectiveness ratios (ICERs) were computed and compared across groups. Direct medical costs were obtained from a medical record review that collected records from 92% of patients; 66% of records requested were obtained.

RESULTS

Disease management produced statistically significant survival advantages among all patients (17.4 days, P = .04), among patients with New York Heart Association (NYHA) class III/IV symptoms (47.7 days, P = .02), and among patients with SHF (24.2 days, P = .01). Analyses of direct medical and intervention costs showed no cost savings associated with the intervention. For all patients and considering all-cause medical care, the ICER was $146 870 per quality-adjusted life-year (QALY) gained, while for patients with NYHA class III/IV symptoms and patients with SHF, the ICERs were $67 784 and $95 721 per QALY gained, respectively. Costs per QALY gained were $101 120 for all patients, $72 501 for patients with SHF, and $41 348 for patients with NYHA class III/IV symptoms.

CONCLUSIONS

The intervention was effective but costly to implement and did not reduce utilization. It may not be cost-effective in other broadly representative samples of patients. However, with program cost reductions and proper targeting, this program may produce life-span increases at costs that are less than $100 000 per QALY gained.

Authors+Show Affiliations

Altarum Institute, 3737 Broadway, Ste 205, San Antonio, TX 78209, USA. brad.smith@altarum.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

18269306

Citation

Smith, Brad, et al. "Cost-effectiveness of Telephonic Disease Management in Heart Failure." The American Journal of Managed Care, vol. 14, no. 2, 2008, pp. 106-15.
Smith B, Hughes-Cromwick PF, Forkner E, et al. Cost-effectiveness of telephonic disease management in heart failure. Am J Manag Care. 2008;14(2):106-15.
Smith, B., Hughes-Cromwick, P. F., Forkner, E., & Galbreath, A. D. (2008). Cost-effectiveness of telephonic disease management in heart failure. The American Journal of Managed Care, 14(2), 106-15.
Smith B, et al. Cost-effectiveness of Telephonic Disease Management in Heart Failure. Am J Manag Care. 2008;14(2):106-15. PubMed PMID: 18269306.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of telephonic disease management in heart failure. AU - Smith,Brad, AU - Hughes-Cromwick,Paul F, AU - Forkner,Emma, AU - Galbreath,Autumn Dawn, PY - 2008/2/14/pubmed PY - 2008/3/8/medline PY - 2008/2/14/entrez SP - 106 EP - 15 JF - The American journal of managed care JO - Am J Manag Care VL - 14 IS - 2 N2 - OBJECTIVE: To evaluate the cost-effectiveness of a telephonic disease management (DM) intervention in heart failure (HF). STUDY DESIGN: Randomized controlled trial of telephonic DM among 1069 community-dwelling patients with systolic HF (SHF) and diastolic HF performed between 1999 and 2003. The enrollment period was 18 months per subject. METHODS: Bootstrap-resampled incremental cost-effectiveness ratios (ICERs) were computed and compared across groups. Direct medical costs were obtained from a medical record review that collected records from 92% of patients; 66% of records requested were obtained. RESULTS: Disease management produced statistically significant survival advantages among all patients (17.4 days, P = .04), among patients with New York Heart Association (NYHA) class III/IV symptoms (47.7 days, P = .02), and among patients with SHF (24.2 days, P = .01). Analyses of direct medical and intervention costs showed no cost savings associated with the intervention. For all patients and considering all-cause medical care, the ICER was $146 870 per quality-adjusted life-year (QALY) gained, while for patients with NYHA class III/IV symptoms and patients with SHF, the ICERs were $67 784 and $95 721 per QALY gained, respectively. Costs per QALY gained were $101 120 for all patients, $72 501 for patients with SHF, and $41 348 for patients with NYHA class III/IV symptoms. CONCLUSIONS: The intervention was effective but costly to implement and did not reduce utilization. It may not be cost-effective in other broadly representative samples of patients. However, with program cost reductions and proper targeting, this program may produce life-span increases at costs that are less than $100 000 per QALY gained. SN - 1936-2692 UR - https://www.unboundmedicine.com/medline/citation/18269306/Cost_effectiveness_of_telephonic_disease_management_in_heart_failure_ L2 - https://www.ajmc.com/pubMed.php?pii=7020 DB - PRIME DP - Unbound Medicine ER -