Cost-Effectiveness of Transitional Care Services After Hospitalization With Heart Failure.

Abstract

Patients with heart failure (HF) discharged from the hospital are at high risk for death and rehospitalization. Transitional care service interventions attempt to mitigate these risks. To assess the cost-effectiveness of 3 types of postdischarge HF transitional care services and standard care. Decision analytic microsimulation model. Randomized controlled trials, clinical registries, cohort studies, Centers for Disease Control and Prevention life tables, Centers for Medicare & Medicaid Services data, and National Inpatient Sample (Healthcare Cost and Utilization Project) data. Patients with HF who were aged 75 years at hospital discharge. Lifetime. Health care sector. Disease management clinics, nurse home visits (NHVs), and nurse case management. Quality-adjusted life-years (QALYs), costs, net monetary benefits, and incremental cost-effectiveness ratios (ICERs). All 3 transitional care interventions examined were more costly and effective than standard care, with NHVs dominating the other 2 interventions. Compared with standard care, NHVs increased QALYs (2.49 vs. 2.25) and costs ($81327 vs. $76705), resulting in an ICER of $19570 per QALY gained. Results were largely insensitive to variations in in-hospital mortality, age at baseline, or costs of rehospitalization. Probabilistic sensitivity analysis confirmed that transitional care services were preferred over standard care in nearly all 10000 samples, at willingness-to-pay thresholds of $50000 or more per QALY gained. Transitional care service designs and implementations are heterogeneous, leading to uncertainty about intervention effectiveness and costs when applied in particular settings. In older patients with HF, transitional care services are economically attractive, with NHVs being the most cost-effective strategy in many situations. Transitional care services should become the standard of care for postdischarge management of patients with HF. Swiss National Science Foundation, Research Council of Norway, and an Intermountain-Stanford collaboration.