Abstract
ObjectiveTo evaluate the cost-effectiveness of the Cardiac Care Bridge (CCB) nurse-led transitional care program in older (≥70 years) cardiac patients compared to usual care.MethodsThe intervention group (n = 153) received the CCB program consisting of case management, disease management and home-based cardiac rehabilitation in the transition from hospital to home on top of usual care and was compared with the usual care group (n = 153). Outcomes included a composite measure of first all-cause unplanned hospital readmission or mortality, Quality Adjusted Life Years (QALYs) and societal costs within six months follow-up. Missing data were imputed using multiple imputation. Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated by using bootstrapped seemingly unrelated regression.ResultsNo significant between group differences in the composite outcome of readmission or mortality nor in societal costs were observed. QALYs were statistically significantly lower in the intervention group, mean difference -0.03 (95% CI: -0.07; -0.02). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.31 at a Willingness To Pay (WTP) of €0,00 and 0.14 at a WTP of €50,000 per composite outcome prevented and 0.32 and 0.21, respectively per QALY gained.ConclusionThe CCB program was on average more expensive and less effective compared to usual care, indicating that the CCB program is dominated by usual care. Therefore, the CCB program cannot be considered cost-effective compared to usual care.
Highlights
Cardiac disease is the leading cause of hospitalization and mortality in older individuals and leads to substantial healthcare costs [1, 2]
The Cardiac Care Bridge (CCB) program was on average more expensive and less effective compared to usual care, indicating that the CCB program is dominated by usual care
The CCB program cannot be considered cost-effective compared to usual care
Summary
Cardiac disease is the leading cause of hospitalization and mortality in older individuals and leads to substantial healthcare costs [1, 2]. 14% of total US healthcare costs [1] and approximately 12% of the total healthcare expenditure in the Netherlands are caused by cardiac disease and the majority of costs is incurred in older individuals [3]. Geriatric conditions lead to physical and cognitive limitations, thereby complicating medical treatment and care during and after discharge. This increases the risk of adverse outcomes such as hospital readmission [6] and contribute to high healthcare costs [7]. There is increasing evidence that a large proportion of costly readmissions can be prevented [8]
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