Heart failure causes significant health and financial burdens for patients and society.
Multidisciplinary management program (MMP) and exercise training program (ETP) have
been reported as cost-effective in improving health outcomes, yet no study has compared
the 2 programs. We constructed a Markov model to simulate life year (LY) gained and
total costs in usual care (UC), MMP, and ETP. The probability of transitions between
states and healthcare costs were extracted from previous literature. We calculated
the incremental cost-effectiveness ratio (ICER) over a 10-year horizon. Model robustness
was assessed through 1-way and probabilistic sensitivity analyses. The expected LY
for patients treated with UC, MMP, and ETP was 7.6, 8.2, and 8.4 years, respectively.
From a societal perspective, the expected cost of MMP was $20,695, slightly higher
than the cost of UC ($20,092). The cost of ETP was much higher ($48,378) because of
its high implementation expense and the wage loss it incurred. The ICER of MMP versus
UC was $976 per LY gained, and the ICER of ETP versus MMP was $165,702 per LY gained.
The results indicated that, under current cost-effectiveness threshold, MMP is cost-effective
compared with UC, and ETP is not cost-effective compared with MMP. However, ETP is
cost-effective compared with MMP from a healthcare payer's perspective.
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Article Info
Publication History
Published online: July 21, 2017
Accepted:
June 30,
2017
Received:
March 15,
2017
Footnotes
See page 1343 for disclosure information.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
