Is multidisciplinary care of heart failure cost-beneficial when combined with optimal medical care?

Eur J Heart Fail. 2003 Jun;5(3):381-9. doi: 10.1016/s1388-9842(02)00235-0.


Background: Multidisciplinary care (MDC) of heart failure (HF) can significantly reduce rates of unplanned hospitalisation, the major cost component of HF care.

Aims: This prospective, randomised, controlled study examines the cost-benefits of MDC of HF in the setting of optimal medical care.

Methods: 98 NYHA class IV HF patients (mean age 70.8+/-10.5 years) were randomised to MDC (n=51) or routine care (RC; n=47) of HF. A direct intervention cost was calculated from contact time (scheduled and unscheduled) spent by the MDC team. Unplanned hospitalisation costs for HF were calculated at a daily rate of 242. Outcomes were determined in monetary terms, i.e. the cost of the service per hospitalisation prevented and net costs/savings at 3 months.

Results: The direct intervention cost of the MDC team was 5860, with an average cost per patient of 113 (95% Cl: 97-128). At 3 months, there were a total of 12 unplanned HF readmissions in the RC group (25.5% rate, 195 days) compared to 2 in the MDC group (3.9% rate, 17 days). The number needed to treat to prevent one hospitalisation for HF was 6 over 3 months. The cost of the service per hospitalisation prevented was 586. The intervention produced a net cost saving of 37,216 for 51 patients treated over 3 months. Sensitivity analyses using 50% variation in costs and lower relative risk reductions confirmed the cost-benefits of the intervention.

Conclusion: MDC of HF remains cost-beneficial when combined with optimal, medical care. The significant clinical and cost-benefits suggest that this intensive approach to MDC and medical management should become the standard of care for HF.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiotensin-Converting Enzyme Inhibitors / administration & dosage
  • Angiotensin-Converting Enzyme Inhibitors / economics
  • Cost-Benefit Analysis / economics
  • Decision Making
  • Digoxin / administration & dosage
  • Digoxin / economics
  • Diuretics / administration & dosage
  • Diuretics / economics
  • Dose-Response Relationship, Drug
  • Female
  • Furosemide / administration & dosage
  • Furosemide / economics
  • Health Care Costs*
  • Heart Failure / diagnosis
  • Heart Failure / economics*
  • Heart Failure / therapy
  • Hospitalization / economics
  • Humans
  • Ireland
  • Length of Stay / economics
  • Male
  • Middle Aged
  • Perindopril / administration & dosage
  • Perindopril / economics
  • Prospective Studies
  • Time Factors
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / economics
  • Ventricular Dysfunction, Left / therapy


  • Angiotensin-Converting Enzyme Inhibitors
  • Diuretics
  • Digoxin
  • Furosemide
  • Perindopril