Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-25T18:57:37.779Z Has data issue: false hasContentIssue false
  • English
  • Français

COST-UTILITY ANALYSIS OF NT-PROBNP-GUIDED MULTIDISCIPLINARY CARE IN CHRONIC HEART FAILURE

Published online by Cambridge University Press:  20 December 2012

Deddo Moertl ,
Sabine Steiner ,
Doug Coyle  and
Rudolf Berger
Deddo Moertl
Affiliation:
Department of Internal Medicine III (Cardiology and Emergency Medicine), Landesklinikum St. Poelten, St. Poelten, Austria; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
Sabine Steiner
Affiliation:
Department of Internal Medicine II, Division of Vascular Medicine, Medical University of Vienna, Vienna, Austria; Prevention and Rehabilitation Centre, Heart Institute, University of Ottawa, Ottawa, Canada
Doug Coyle
Affiliation:
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
Rudolf Berger
Affiliation:
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: A recent randomized, controlled trial in chronic heart failure patients showed that NT-proBNP-guided, intensive patient management (BMC) on top of multidisciplinary care reduced all-cause mortality and heart failure hospitalizations compared with multidisciplinary care (MC) or usual care (UC). We now performed a cost-utility analysis of these interventions from a payer's perspective.

Methods: Costs related to hospitalizations, ambulatory physician and nurse visits, and NT-proBNP testing for the three management strategies were acquired for both Austria (€) and Canada ($) and combined with the survival and quality of life data from the clinical trial for cost-effectiveness analysis. Data on long-term survival, costs, and quality-adjusted life-years (QALY) were extrapolated for a 20-year time horizon using a Markov model, which simulated the progression of disease through beta-blocker use, hospitalizations, and mortality.

Results: BMC was the most cost-effective strategy as it was dominant (cost-saving with improved health outcome) over both MC and UC based on both Austrian and Canadian costs. Incremental cost-effectiveness ratios for MC relative to UC were €3,746 and $5,554 per QALY gained for Austrian and Canadian costs, respectively. The probabilities for BMC being the most cost-effective strategy were 92 percent at a threshold value of Austrian €40,000 and 93 percent at a threshold value of Canadian $50,000.

Conclusions: NT-proBNP-guided, intensive HF patient management in addition to multidisciplinary care not only reduces death and hospitalization but also proves to be cost-effective.

Keywords

Cost-effectivenessHeart failureNatriuretic peptidesDisease management programsMarkov model
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 1 , January 2013 , pp. 3 - 11
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Stewart, S, MacIntyre, K, Hole, DJ, Capewell, S, McMurray, JJ. More ‘malignant’ than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail. 2001;3:315–22.CrossRefGoogle ScholarPubMed
2.Fonarow, GC, Abraham, WT, Albert, NM, et al.Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA. 2007;297:61–70.CrossRefGoogle ScholarPubMed
3.Stewart, S. Financial aspects of heart failure programs of care. Eur J Heart Fail. 2005;7:423–8.CrossRefGoogle ScholarPubMed
4.Berry, C, Murdoch, DR, McMurray, JJ. Economics of chronic heart failure. Eur J Heart Fail. 2001;3:283–91.CrossRefGoogle ScholarPubMed
5.McAlister, FA, Lawson, FM, Teo, KK, Armstrong, PW. A systematic review of randomized trials of disease management programs in heart failure. Am J Med. 2001;110:378–84.CrossRefGoogle ScholarPubMed
6.Krumholz, HM, Amatruda, J, Smith, GL, et al.Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. J Am Coll Cardiol. 2002;39:83–9.CrossRefGoogle ScholarPubMed
7.Gonseth, J, Guallar-Castillon, P, Banegas, JR, Rodriguez-Artalejo, F. The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J. 2004;25:1570–95.CrossRefGoogle ScholarPubMed
8.Kimmelstiel, C, Levine, D, Perry, K, et al.Randomized, controlled evaluation of short- and long-term benefits of heart failure disease management within a diverse provider network: the SPAN-CHF trial. Circulation. 2004;110:1450–5.CrossRefGoogle Scholar
9.Inglis, SC, Pearson, S, Treen, S, Gallasch, T, Horowitz, JD, Stewart, S. Extending the horizon in chronic heart failure: effects of multidisciplinary, home-based intervention relative to usual care. Circulation. 2006;114:2466–73.CrossRefGoogle ScholarPubMed
10.Berger, R, Moertl, D, Peter, S, et al.N-terminal pro-B-type natriuretic peptide-guided, intensive patient management in addition to multidisciplinary care in chronic heart failure a 3-arm, prospective, randomized pilot study. J Am Coll Cardiol. 2010;55:645–53.CrossRefGoogle ScholarPubMed
11.Adlbrecht, C, Huelsmann, M, Berger, R, et al.Cost analysis and cost effectiveness of NT-proBNP-guided heart failure specialist care in addition to home-based nurse care. Eur J Clin Invest. 2011;41:315–22.CrossRefGoogle ScholarPubMed
12.Havranek, EP, McGovern, KM, Weinberger, J, et al.Patient preferences for heart failure treatment: utilities are valid measures of health-related quality of life in heart failure. J Card Fail. 1999;5:85–91.CrossRefGoogle ScholarPubMed
13.Delea, TE, Vera-Llonch, M, Richner, RE, Fowler, MB, Oster, G. Cost effectiveness of carvedilol for heart failure. Am J Cardiol. 1999;83:890–6.CrossRefGoogle ScholarPubMed
14.Levy, AR, Briggs, AH, Demers, C, O'Brien, BJ. Cost-effectiveness of beta-blocker therapy with metoprolol or with carvedilol for treatment of heart failure in Canada. Am Heart J. 2001;142:537–43.CrossRefGoogle ScholarPubMed
15.Gohler, A, Conrads-Frank, A, Worrell, SS, et al.Decision-analytic evaluation of the clinical effectiveness and cost-effectiveness of management programmes in chronic heart failure. Eur J Heart Fail. 2008;10:1026–32.CrossRefGoogle ScholarPubMed
16.Reitsma, JB, Mosterd, A, de Craen, AJ, et al.Increase in hospital admission rates for heart failure in The Netherlands, 1980-1993. Heart. 1996;76:388–92.CrossRefGoogle ScholarPubMed
17.Gohler, A, Geisler, BP, Manne, JM, et al.Utility estimates for decision-analytic modeling in chronic heart failure–health states based on New York Heart Association classes and number of rehospitalizations. Value Health. 2009;12:185–7.CrossRefGoogle ScholarPubMed
18.Briggs, AH. Handling uncertainty in cost-effectiveness models. Pharmacoeconomics. 2000;17:479–500.CrossRefGoogle ScholarPubMed
19.Grosse, SD. Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res. 2008;8:165–78.CrossRefGoogle Scholar
20.Jaarsma, T, van der Wal, MH, Lesman-Leegte, I, et al.Effect of moderate or intensive disease management program on outcome in patients with heart failure: Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH). Arch Intern Med. 2008;168:316–24.CrossRefGoogle ScholarPubMed
21.McMurray, JJ, Adamopoulos, S, Anker, SD, et al.ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787–847.Google Scholar
22.Capomolla, S, Febo, O, Ceresa, M, et al.Cost/utility ratio in chronic heart failure: comparison between heart failure management program delivered by day-hospital and usual care. J Am Coll Cardiol. 2002;40:1259–66.CrossRefGoogle ScholarPubMed
23.Chan, DC, Heidenreich, PA, Weinstein, MC, Fonarow, GC. Heart failure disease management programs: a cost-effectiveness analysis. Am Heart J. 2008;155:332–8.CrossRefGoogle ScholarPubMed
24.Solomon, SD, Dobson, J, Pocock, S, et al.Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circulation. 2007;116:1482–7.CrossRefGoogle ScholarPubMed
25.Fox, M, Mealing, S, Anderson, R, et al.The clinical effectiveness and cost-effectiveness of cardiac resynchronization (biventricular pacing) for heart failure: systematic review and economic model. Health Technol Assess. 2007;11:iii–iv, ix-248.CrossRefGoogle Scholar
Supplementary material: File

Moertl Supplementary Material

Appendix

Download Moertl Supplementary Material(File)
File 19.8 KB
Supplementary material: Image

Moertl et al supplementary figure

Supplementary figure 1

Download Moertl et al supplementary figure(Image)
Image 18.4 KB
Supplementary material: Image

Moertl et al supplementary figure

Supplementary figure 2

Download Moertl et al supplementary figure(Image)
Image 17.8 KB