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Monday, 18 October 2004 - 2:00 PM

This presentation is part of: Oral Concurrent Session B - Clinical Effectiveness and Quality of Life

CLINICAL EFFECTIVENESS AND COST-EFFECTIVENESS OF DISEASE MANAGEMENT PROGRAMS FOR PATIENTS WITH HEART FAILURE

Alexander Gohler, MD, Charitè Campus Virchow Klinikum, Humboldt Medical School, Division of Cardiology, Berlin, Germany, Rainer Dietz, MD, Charitè Campus Virchow Klinikum, Humboldt Medical School, Divison of Cardiology, Berlin, Germany, Karl Josef Osterziel, MD, Charitè Campus Virchow Klinikum, Humboldt Medical School, Divison in Cardiology, Berlin, Germany, and Uwe Siebert, MD, MPH, MSc, Massachusetts General Hospital, Harvard Medical School, Institute for Technology Assessment and Department of Radiology, Boston, MA.

Purpose: Congestive heart failure (CHF) is a major cause of morbidity and mortality in the population. Currently causing 40% of hospitalization of the elderly and 1%-2% of the annual health care expenses it is likely to escalate in the next decades. In a meta-analysis of 16 randomized controlled trials investigating disease management programs (DMP) in the treatment of CHF, we could show a statistically significant reduction in mortality and rehospitalization, but cost-effectiveness of DMPs remains uncertain. Therefore, we sought to evaluate life expectancy and life long medical costs for DMPs.

Methods: Design: Cost and cost-effectiveness analysis using a 6 state Markov Model representing the number of prior hospitalizations (h=1 to h=4+) and death. Data sources: Pooled efficacy data from our meta-analyses of randomised clinical trials; SOLVD registry data for age-dependent hospitalizations and mortality rates adjusted for additional benefit from beta-blocker therapy and reimbursement costs in the Australian health care system. Target population: All patients who have been admitted with severe heart failure. Time horizon: Lifetime. Perspective: Societal. Intervention: Conventional therapy and DMP. Outcome measures: Life years gained and lifetime direct medical costs.

Results: For a population aged 73 at onset of CHF (27% female, 33% on beta-blocker), our model yielded, on average, a remaining life expectancy of 3.24 years for conventional therapy and 3.38 years for DMP. Mean undiscounted lifetime costs per patient were estimated at EUR 11,600 and EUR 12,700 respectively. The discounted incremental cost-effectiveness ratio (ICER) of DMP vs. conventional care was EUR 8,813 per life-year-gained (LYG). Assuming the benefit due to DMP lasting for 5 years after the end of the actual intervention would lead to additional 5 life months and reduce ICER to 4,021 EUR/LYG.

Conclusion: Based on our decision analysis, DMPs prolong life, but increase life-time costs. A cost-saving effect of DMPs (i.e., more effective and less costly) as suggested in some original studies could not be confirmed in our decision analysis. However, even under conservative assumptions regarding the duration of DMP, these programs are cost-effective when compared to other well-accepted medical interventions in heart disease.


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See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)