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Decision-analytic evaluation of the clinical effectiveness and cost-effectiveness of management programmes in chronic heart failure

Authors

  • A. Goehler
  • A. Conrads-Frank
  • S.S. Worrell
  • B.P. Geisler
  • E.F. Halpern
  • R. Dietz
  • S.D. Anker
  • G.S. Gazelle
  • U. Siebert

Journal

  • European Journal of Heart Failure

Citation

  • Eur J Heart Fail 10 (10): 1026-1032

Abstract

  • BACKGROUND AND AIMS: While management programmes (MPs) for chronic heart failure (CHF) are clinically effective, their cost-effectiveness remains uncertain. Thus, this study sought to determine the cost-effectiveness of MPs. METHODS AND RESULTS: We developed a Markov model to estimate life expectancy, quality-adjusted life expectancy, lifetime costs, and the incremental cost-effectiveness of MPs as compared to standard care. Standard care was defined by the EuroHeart Failure Survey for Germany, MP efficacy was derived from our recent meta-analysis and cost estimates were based on the German healthcare system. For a population with a mean age 67 years (35% female) at onset of CHF, our model predicted an average quality-adjusted life expectancy of 2.64 years for standard care and 2.83 years for MP. MP yielded additional lifetime costs of euro1700 resulting in an incremental cost-utility ratio (ICUR) of euro8900 (95% CI: dominant to 177,100) per quality-adjusted life year (QALY) gained. Sensitivity analyses demonstrated that the ICUR was sensitive to age and sex. CONCLUSION: MPs increase life expectancy in patients with CHF by an average of 84 days and increase lifetime cost of care by approximately euro1700. MPs improve outcomes in a cost-effective manner, although they are not cost-saving on a lifetime horizon.


DOI

doi:10.1016/j.ejheart.2008.07.018