MONDAY, Jan. 27, 2020 — Transitional care services are cost-effective for the postdischarge management of older patients with heart failure, according to a study published online Jan. 28 in the Annals of Internal Medicine.
Manuel R. Blum, M.D., from the Stanford University School of Medicine in California, and colleagues examined the cost-effectiveness of three types of postdischarge heart failure transitional care services (nurse home visits [NHVs], nurse case management, and disease management clinics) compared to standard care in a decision analytic microsimulation model. The population included patients with heart failure who were aged 75 years at hospital discharge.
The researchers found that in the base-case analysis, compared with standard care, all three transitional care interventions examined were more costly and effective, with NHVs dominating disease management clinics and nurse case management. NHVs increased quality-adjusted life years (QALYs: 2.49 versus 2.25) and costs ($81,367 versus $76,705) compared with standard care, resulting in an incremental cost-effectiveness ratio of $19,570 per QALY gained. In sensitivity analyses, results were mainly insensitive to variations of in-hospital mortality, age at baseline, or rehospitalization costs. In nearly all 10,000 samples, transitional care services were preferred over standard care at willingness-to-pay thresholds of $50,000 or more per QALY gained.
“Each of the interventions resulted in important improvements in health outcomes, and the differences among the interventions were modest,” the authors write. “Implementation of one of the transitional care services included in this analysis would be preferred to standard care.”
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Posted: January 2020