PMID- 12383573
OWN - NLM
STAT- MEDLINE
DCOM- 20021104
LR  - 20191210
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 40
IP  - 7
DP  - 2002 Oct 2
TI  - Cost/utility ratio in chronic heart failure: comparison between heart failure 
      management program delivered by day-hospital and usual care.
PG  - 1259-66
AB  - OBJECTIVE: This study compared the effectiveness and cost/utility ratio between a 
      heart failure (HF) management program delivered by day-hospital (DH) and usual 
      care in chronic heart failure (CHF) outpatients. BACKGROUND: Previous studies 
      showed that about 50% of readmissions for CHF can be prevented by a 
      multidisciplinary approach. However, the performance, effectiveness, and 
      cost/utility ratio of a process of HF outpatient management related to 
      evidence-based medicine have not been considered. METHODS: A total of 234 
      prospective patients discharged by a HF Unit were randomized to two management 
      strategies: 122 patients to usual community care and 112 patients to a HF 
      management program delivered by the DH. Management (rate of readmissions, 
      therapeutic interventions), functional parameters (New York Heart Association 
      [NYHA] functional class, left ventricular diameters, and ejection fraction, 
      deceleration time of early diastolic mitral flow, peak oxygen uptake, and mitral 
      regurgitation) and hard outcomes (cardiac death and urgent cardiac 
      transplantation) were evaluated. The cost/utility ratios of the two strategies 
      were compared. RESULTS: After 12 +/- 3 months of follow-up, the individual rate 
      access in DH was 5.5 +/- 3.8 days. The DH subjects were readmitted to the 
      hospital less frequently than were the usual-care group patients (13 vs. 78, p < 
      0.00001). Patients allocated to usual-care management showed heterogeneous 
      changes in NYHA functional class (13% improved and 16% worsened p = NS); In 
      contrast, the DH group showed significant changes in NYHA functional class (23% 
      improved and 11% worsened, p < 0.009). Hard cardiac events in the one-year 
      follow-up occurred in 25/234 (10.6%) patients; cardiac death occurred in 21/122 
      (17.2%) of the community group and in 3/112 (2.7%) in the DH group (p < 0.0007). 
      One DH patient underwent urgent transplantation. Comparison of the two managerial 
      models by Cox regression analysis showed that DH management significantly 
      protected against the appearance of hard events (relative risk [RR] 0.17; 
      confidence interval [CI] 0.06 to 0.66). The cost/utility ratio of the two 
      management strategies was similar (usual care $2,409 vs. DH $2,244). The 
      incremental analysis revealed a cost savings of $1,068 for each quality-adjusted 
      life year gained. The cost/utility ratio for the integration of DH management of 
      CHF was $19,462 (CI $13,904 to $34,048). CONCLUSIONS: A heart failure outpatient 
      management program delivered by a DH can reduce mortality and morbidity of CHF 
      patients. This management strategy is cost-effective and has an equitable value 
      from a societal point of view.
FAU - Capomolla, Soccorso
AU  - Capomolla S
AD  - Fondazione Salvatore Maugeri, IRCCS, Dipartimento di Cardiologia, Istituto 
      Scientifico di Montescano, Montescano, Pavia, Italy. scapomolla@fsm.it
FAU - Febo, Oreste
AU  - Febo O
FAU - Ceresa, Monica
AU  - Ceresa M
FAU - Caporotondi, Angelo
AU  - Caporotondi A
FAU - Guazzotti, Giampaolo
AU  - Guazzotti G
FAU - La Rovere, Maria
AU  - La Rovere M
FAU - Ferrari, Marina
AU  - Ferrari M
FAU - Lenta, Francesca
AU  - Lenta F
FAU - Baldin, Sonia
AU  - Baldin S
FAU - Vaccarini, Chiara
AU  - Vaccarini C
FAU - Gnemmi, Marco
AU  - Gnemmi M
FAU - Pinna, GianDomenico
AU  - Pinna G
FAU - Maestri, Roberto
AU  - Maestri R
FAU - Abelli, Paola
AU  - Abelli P
FAU - Verdirosi, Sandro
AU  - Verdirosi S
FAU - Cobelli, Franco
AU  - Cobelli F
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2003 May 21;41(10):1850; author reply 1850-1. PMID: 12767681
MH  - Aged
MH  - Ambulatory Care/*economics/standards/statistics & numerical data
MH  - Cost Savings
MH  - Cost-Benefit Analysis
MH  - Day Care, Medical/*economics/standards/statistics & numerical data
MH  - Female
MH  - *Health Care Costs
MH  - Health Services Research
MH  - Heart Failure/*economics/mortality/*therapy
MH  - Heart Transplantation/statistics & numerical data
MH  - Humans
MH  - Italy/epidemiology
MH  - Life Expectancy
MH  - Male
MH  - Middle Aged
MH  - Outcome and Process Assessment, Health Care
MH  - Patient Care Team/organization & administration
MH  - Patient Readmission/statistics & numerical data
MH  - Program Evaluation
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Quality-Adjusted Life Years
MH  - Sensitivity and Specificity
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Survival Analysis
MH  - *Treatment Outcome
EDAT- 2002/10/18 04:00
MHDA- 2002/11/26 04:00
CRDT- 2002/10/18 04:00
PHST- 2002/10/18 04:00 [pubmed]
PHST- 2002/11/26 04:00 [medline]
PHST- 2002/10/18 04:00 [entrez]
AID - S073510970202140X [pii]
AID - 10.1016/s0735-1097(02)02140-x [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2002 Oct 2;40(7):1259-66. doi: 10.1016/s0735-1097(02)02140-x.