Cost-Effectiveness of Transitional Care Services After Hospitalization With Heart Failure

Abstract

Background: 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.

Objective: To assess the cost-effectiveness of 3 types of postdischarge HF transitional care services and standard care.

Design: Decision analytic microsimulation model.

Data sources: 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.

Target population: Patients with HF who were aged 75 years at hospital discharge.

Time horizon: Lifetime.

Perspective: Health care sector.

Intervention: Disease management clinics, nurse home visits (NHVs), and nurse case management.

Outcome measures: 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 of sensitivity analysis: 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.

Limitation: Transitional care service designs and implementations are heterogeneous, leading to uncertainty about intervention effectiveness and costs when applied in particular settings.

Conclusion: 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.

Primary funding source: Swiss National Science Foundation, Research Council of Norway, and an Intermountain-Stanford collaboration.