Tools for economic analysis of patient management interventions in heart failure cost-effectiveness model: a web-based program designed to evaluate the cost-effectiveness of disease management programs in heart failure

Reed, S. D. et al. (2015) Tools for economic analysis of patient management interventions in heart failure cost-effectiveness model: a web-based program designed to evaluate the cost-effectiveness of disease management programs in heart failure. American Heart Journal, 170(5), pp. 951-960. (doi: 10.1016/j.ahj.2015.08.015) (PMID:26542504)

Abstract

Background: Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable. Methods: We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics; use of evidence-based medications; and costs to generate predicted outcomes. Survival projections are based on a modified Seattle Heart Failure Model. Projections of resource use and quality of life are modeled using relationships with time-varying Seattle Heart Failure Model scores. The model can be used to evaluate parallel-group and single-cohort study designs and hypothetical programs. Simulations consist of 10,000 pairs of virtual cohorts used to generate estimates of resource use, costs, survival, and incremental cost-effectiveness ratios from user inputs. Results: The model demonstrated acceptable internal and external validity in replicating resource use, costs, and survival estimates from 3 clinical trials. Simulations to evaluate the cost-effectiveness of heart failure disease management programs across 3 scenarios demonstrate how the model can be used to design a program in which short-term improvements in functioning and use of evidence-based treatments are sufficient to demonstrate good long-term value to the health care system. Conclusion: The Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model provides researchers and providers with a tool for conducting long-term cost-effectiveness analyses of disease management programs in heart failure. Although economic evaluations of heart failure disease management programs are plentiful, a recent review identified only 2 formal cost-effectiveness analyses that extrapolated beyond a trial's follow-up period.1 Without extrapolation, the value of a disease management program may be underestimated. For example, an analysis of the South Texas Congestive Heart Failure Disease Management Project reported an incremental cost-effectiveness ratio >$100,000 per quality-adjusted life-year (QALY) within the trial's 18-month follow-up period.2 However, extension of the time horizon with a Markov model structured using New York Heart Association (NYHA) classification reduced the incremental cost-effectiveness ratio to >$50,000 per QALY.3 This example demonstrates the importance of accounting for all downstream costs and health benefits attributable to an intervention to provide a fair assessment of its cost-effectiveness. With support from the National Institute of Nursing Research, we developed user-friendly tools to facilitate high-quality economic evaluations of patient-focused interventions. In our project, Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF), we developed a costing tool4 and a cost-effectiveness model. In this article, we describe the TEAM-HF Cost-Effectiveness Model, a generalizable, Web-based tool designed to assist researchers, administrators, and providers in estimating short- or long-term estimates of resource use, costs, and cost-effectiveness of disease management programs or other care strategies in heart failure. We then compare predicted estimates of resource use and costs from the model to estimates from 3 studies to evaluate the internal and external validity of the model. We also evaluate the potential cost-effectiveness of 3 disease management scenarios to demonstrate how the model can be used to design more cost-effective interventions.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Briggs, Professor Andrew
• Authors: Reed, S. D., Neilson, M. P., Gardner, M., Li, Y., Briggs, A. H., Polsky, D. E., Graham, F. L., Bowers, M. T., Paul, S. C., Granger, B. B., Schulman, K. A., Whellan, D. J., Riegel, B., and Levy, W. C.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: American Heart Journal
• Publisher: Elsevier
• ISSN: 0002-8703
• ISSN (Online): 1097-6744
• Published Online: 20 August 2015
• Copyright Holders: Copyright © 2015 Elsevier Inc.
• First Published: First published in American Heart Journal 170(5): 951-960
• Publisher Policy: Reproduced in accordance with the publisher copyright policy