Stanford University School of Medicine, Stanford, California, and Bern University Hospital and University of Bern, Bern, Switzerland (M.R.B.).
Norwegian Institute of Public Health, Oslo, Norway, and Stanford University, Stanford, California (H.Ø.).
Ann Intern Med. 2020 Feb 18;172(4):248-257. doi: 10.7326/M19-1980. Epub 2020 Jan 28.
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.
To assess the cost-effectiveness of 3 types of postdischarge HF transitional care services and standard care.
Decision analytic microsimulation model.
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.
Patients with HF who were aged 75 years at hospital discharge.
Lifetime.
Health care sector.
Disease management clinics, nurse home visits (NHVs), and nurse case management.
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 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.
Transitional care service designs and implementations are heterogeneous, leading to uncertainty about intervention effectiveness and costs when applied in particular settings.
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.
Swiss National Science Foundation, Research Council of Norway, and an Intermountain-Stanford collaboration.
出院的心力衰竭（HF）患者有很高的死亡和再住院风险。过渡护理服务干预试图降低这些风险。
评估 3 种出院后 HF 过渡护理服务和标准护理的成本效益。
决策分析微观模拟模型。
随机对照试验、临床登记、队列研究、疾病控制与预防中心生命表、医疗保险和医疗补助服务数据以及国家住院样本（医疗保健成本和利用项目）数据。
出院时年龄为 75 岁的 HF 患者。
终生。
医疗保健部门。
疾病管理诊所、护士家访（NHV）和护士病例管理。
质量调整生命年（QALY）、成本、净货币收益和增量成本效益比（ICER）。
所有 3 种过渡护理干预均比标准护理更昂贵且更有效，NHV 优于其他 2 种干预。与标准护理相比，NHV 增加了 QALY（2.49 对 2.25）和成本（81327 美元对 76705 美元），导致每获得一个 QALY 的 ICER 为 19570 美元。
结果对住院死亡率、基线年龄或再住院费用的变化基本不敏感。概率敏感性分析证实，在近 10000 个样本中，在每获得一个 QALY 的意愿支付阈值为 50000 美元或更高的情况下，过渡护理服务在几乎所有情况下都优于标准护理。
过渡护理服务的设计和实施存在差异，导致在特定环境下应用时干预效果和成本存在不确定性。
在老年 HF 患者中，过渡护理服务具有成本效益，在许多情况下，NHV 是最具成本效益的策略。过渡护理服务应成为 HF 患者出院后管理的标准。
瑞士国家科学基金会、挪威研究理事会和 Intermountain-Stanford 合作。
