Cost-effectiveness Analysis of Early Blood Volume-Guided Management In Hospitalized Heart Failure Patients

Abstract

Background In a recent retrospective study, the use of early blood volume analysis (BVA) to guide treatment in Hospitalized Heart Failure (HHF) patients was associated with significantly lower readmission rates and mortality. A cost-effectiveness analysis was undertaken to quantify this benefit economically, based on the results of the study. Methods Costs for HHF with and without BVA were estimated from published data. Effectiveness was derived by modeling survival using outcomes from the retrospective study. A 3-state Markov simulation was performed, with all patients initially in state “In Hospital with Heart Failure”, with additional states “Not in Hospital with Heart Failure” and “Dead”. Transition probabilities and uncertainties for in-hospital mortality and readmission were determined by the observed outcomes of the retrospective study. Other parameters for the analysis (transitions, quality adjustments, etc.) were derived from published sources of large population studies. Probabilistic and deterministic sensitivity analysis was performed. Results The incremental cost-effectiveness ratio (ICER) for a 30-year simulation was $10,700. This was derived from an average life-extension of 2.32 quality-adjusted life years (QALYs) per patient, at an incremental cost of $24,800 per patient. Sensitivity analysis showed that the most critical parameters of the simulation were the long-term hospitalization rate for chronic heart failure, the age of the patients, the assumed cost of a single hospitalization, and the marginal cost assumed to be associated with longer Length of Stay (LOS) for subjects. Uncertainty analysis returned an estimate of ICER = $14,200±$5,620, based on incremental QALY = 2.69±1.76 and incremental cost=$35,400±$22,500. A goal-seeking analysis showed that an ICER of $50,000 would be achieved if the reduction in mortality and readmission was as little as 12%. Conclusion Use of BVA to guide treatment was demonstrated to be extremely cost-effective, as ICER values for all scenarios considered were far below the threshold of $50,000 which is generally taken to represent good value for health care.