Cost-Effectiveness of Transitional Care Services After Hospitalization With Heart Failure.

BACKGROUND

Patients with heart failure (HF) discharged from the hospital are at high risk for death and rehospitalization. Transitional care service interventions attempt to mitigate these risks.

OBJECTIVE

To assess the cost-effectiveness of 3 types of postdischarge HF transitional care services and standard care.

DESIGN

Decision analytic microsimulation model.

DATA SOURCES

Randomized controlled trials, clinical registries, cohort studies, Centers for Disease Control and Prevention life tables, Centers for Medicare & Medicaid Services data, and National Inpatient Sample (Healthcare Cost and Utilization Project) data.

TARGET POPULATION

Patients with HF who were aged 75 years at hospital discharge.

TIME HORIZON

Lifetime.

PERSPECTIVE

Health care sector.

INTERVENTION

Disease management clinics, nurse home visits (NHVs), and nurse case management.

OUTCOME MEASURES

Quality-adjusted life-years (QALYs), costs, net monetary benefits, and incremental cost-effectiveness ratios (ICERs).

RESULTS OF BASE-CASE ANALYSIS: All 3 transitional care interventions examined were more costly and effective than standard care, with NHVs dominating the other 2 interventions. Compared with standard care, NHVs increased QALYs (2.49 vs. 2.25) and costs ($81 327 vs. $76 705), resulting in an ICER of $19 570 per QALY gained.

RESULTS OF SENSITIVITY ANALYSIS

Results were largely insensitive to variations in in-hospital mortality, age at baseline, or costs of rehospitalization. Probabilistic sensitivity analysis confirmed that transitional care services were preferred over standard care in nearly all 10 000 samples, at willingness-to-pay thresholds of $50 000 or more per QALY gained.

LIMITATION

Transitional care service designs and implementations are heterogeneous, leading to uncertainty about intervention effectiveness and costs when applied in particular settings.

CONCLUSION

In older patients with HF, transitional care services are economically attractive, with NHVs being the most cost-effective strategy in many situations. Transitional care services should become the standard of care for postdischarge management of patients with HF.

PRIMARY FUNDING SOURCE

Swiss National Science Foundation, Research Council of Norway, and an Intermountain-Stanford collaboration.