Abstract 29: Cost-effectiveness of Inpatient Case Management for Heart Failure Patients

Abstract

Background: Prior studies have demonstrated that approximately 5.7 million Americans suffer from heart failure (HF). The direct costs of HF have been estimated at $39.3 billion, and the annual cost of unplanned readmissions is approximately $17.4 billion. Many interventions have been implemented in order to decrease healthcare costs and burden of this disease. Case management (CM) is an intervention that has been utilized in inpatient and outpatient settings. The purpose of this study was to analyze the cost-effectiveness of using CM in addition to usual care in a tertiary hospital that has a large HF population to decrease the 30-day readmission rate. Objectives: We hypothesize that the addition of CM to provide transitional care services to HF patients will decrease 30-day readmission rate, consequently decreasing healthcare utilization costs and improving patient’s quality of life (QoL). Methods: We conducted a cost-effectiveness analysis using a decision analytic model that incorporated Markov processes to evaluate the use of CM for HF patients. We compared two different management strategies following index HF hospitalization: ‘usual care’ versus ‘usual care plus CM’. Our analysis was conducted from a societal perspective with estimated key cost parameters based on established Diagnosis-related Groups (DRGs) and the Healthcare Cost and Utilization Project (HCUP). Lastly, patients’ quality adjusted life years (QALYs) were measured by days spent out of the hospital. Results: In our analysis, ’usual care plus CM’ resulted in cost savings of $696.58 per patient when compared to ‘usual care’ alone for an ACO based health system with large HF patient volume. In addition, ‘usual care plus CM’ was associated with shorter inpatient stay (decrease in 0.35 inpatient days), and a slight increase in QALYs by 0.003. Conclusion: Our study demonstrated that ACO-based health system’s investment in CM in addition to usual care decrease the cost per discharge of complex HF patients.