The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: a decision model-based analysis

Taylor, R. S. et al. (2019) The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: a decision model-based analysis. European Journal of Preventive Cardiology, 26(12), pp. 1252-1261. (doi:10.1177/2047487319833507) (PMID:30884975) (PMCID:PMC6628466)

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Abstract

Background: The REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) trial found that the REACH-HF home-based cardiac rehabilitation intervention resulted in a clinically meaningful improvement in disease-specific health-related quality of life in patients with reduced ejection fraction heart failure (HFrEF). The aims of this study were to assess the long-term cost-effectiveness of the addition of REACH-HF intervention or home-based cardiac rehabilitation to usual care compared with usual care alone in patients with HFrEF. Design and methods: A Markov model was developed using a patient lifetime horizon and integrating evidence from the REACH-HF trial, a systematic review/meta-analysis of randomised trials, estimates of mortality and hospital admission and UK costs at 2015/2016 prices. Taking a UK National Health and Personal Social Services perspective we report the incremental cost per quality-adjusted life-year (QALY) gained, assessing uncertainty using probabilistic and deterministic sensitivity analyses. Results: In base case analysis, the REACH-HF intervention was associated with per patient mean QALY gain of 0.23 and an increased mean cost of £400 compared with usual care, resulting in a cost per QALY gained of £1720. Probabilistic sensitivity analysis indicated a 78% probability that REACH-HF is cost effective versus usual care at a threshold of £20,000 per QALY gained. Results were similar for home-based cardiac rehabilitation versus usual care. Sensitivity analyses indicate the findings to be robust to changes in model assumptions and parameters. Conclusions: Our cost-utility analyses indicate that the addition of the REACH-HF intervention and home-based cardiac rehabilitation programmes are likely to be cost-effective treatment options versus usual care alone in patients with HFrEF.

Item Type:Articles
Additional Information:This work was supported by the United Kingdom’s National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number RP-PG-1210-12004).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Taylor, Professor Rodney Stephen
Authors: Taylor, R. S., Sadler, S., Dalal, H. M., Warren, F. C., Jolly, K., Davis, R. C., Doherty, P., Miles, J., Greaves, C., Wingham, J., Hillsdon, M., Abraham, C., Frost, J., Singh, S., Hayward, C., Eyre, V., Paul, K., Lang, C. C., and Smith, K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO Unit
Journal Name:European Journal of Preventive Cardiology
Publisher:SAGE
ISSN:2047-4873
ISSN (Online):2047-4881
Published Online:18 March 2019
Copyright Holders:Copyright © 2019 The European Society of Cardiology
First Published:First published in European Journal of Preventive Cardiology 26(12):1252-1261
Publisher Policy:Reproduced under a Creative Commons License

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