Cost-effectiveness of telephonic disease management in heart failure

Brad Smith, Paul F. Hughes-Cromwick, Emma Forkner, Autumn Dawn Galbreath

Research output: Contribution to journalArticle

47 Scopus citations

Abstract

Objective: To evaluate the cost-effectiveness of a telephonic disease management (DM) intervention in heart failure (HF). Study Design: Randomized controlled trial of telephonic DM among 1069 community-dwelling patients with systolic HF (SHF) and diastolic HF performed between 1999 and 2003. The enrollment period was 18 months per subject. Methods: Bootstrap-resampled incremental cost-effectiveness ratios (ICERs) were computed and compared across groups. Direct medical costs were obtained from a medical record review that collected records from 92% of patients; 66% of records requested were obtained. Results: Disease management produced statistically significant survival advantages among all patients (17.4 days, P = .04), among patients with New York Heart Association (NYHA) class III/IV symptoms (47.7 days, P = .02), and among patients with SHF (24.2 days, P = .01). Analyses of direct medical and intervention costs showed no cost savings associated with the intervention. For all patients and considering all-cause medical care, the ICER was $146 870 per quality-adjusted life-year (QALY) gained, while for patients with NYHA class III/IV symptoms and patients with SHF, the ICERs were $67 784 and $95 721 per QALY gained, respectively. Costs per QALY gained were $101 120 for all patients, $72 501 for patients with SHF, and $41 348 for patients with NYHA class III/IV symptoms. Conclusions: The intervention was effective but costly to implement and did not reduce utilization. It may not be cost-effective in other broadly representative samples of patients. However, with program cost reductions and proper targeting, this program may produce life-span increases at costs that are less than $100 000 per QALY gained.

Original languageEnglish (US)
Pages (from-to)106-115
Number of pages10
JournalAmerican Journal of Managed Care
Volume14
Issue number2
StatePublished - Feb 1 2008

ASJC Scopus subject areas

  • Health Policy

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    Smith, B., Hughes-Cromwick, P. F., Forkner, E., & Galbreath, A. D. (2008). Cost-effectiveness of telephonic disease management in heart failure. American Journal of Managed Care, 14(2), 106-115.