PMID- 18269306
OWN - NLM
STAT- MEDLINE
DCOM- 20080307
LR  - 20080213
IS  - 1936-2692 (Electronic)
IS  - 1088-0224 (Linking)
VI  - 14
IP  - 2
DP  - 2008 Feb
TI  - Cost-effectiveness of telephonic disease management in heart failure.
PG  - 106-15
AB  - OBJECTIVE: To evaluate the cost-effectiveness of a telephonic disease management 
      (DM) intervention in heart failure (HF). STUDY DESIGN: Randomized controlled 
      trial of telephonic DM among 1069 community-dwelling patients with systolic HF 
      (SHF) and diastolic HF performed between 1999 and 2003. The enrollment period was 
      18 months per subject. METHODS: Bootstrap-resampled incremental 
      cost-effectiveness ratios (ICERs) were computed and compared across groups. 
      Direct medical costs were obtained from a medical record review that collected 
      records from 92% of patients; 66% of records requested were obtained. RESULTS: 
      Disease management produced statistically significant survival advantages among 
      all patients (17.4 days, P = .04), among patients with New York Heart Association 
      (NYHA) class III/IV symptoms (47.7 days, P = .02), and among patients with SHF 
      (24.2 days, P = .01). Analyses of direct medical and intervention costs showed no 
      cost savings associated with the intervention. For all patients and considering 
      all-cause medical care, the ICER was $146 870 per quality-adjusted life-year 
      (QALY) gained, while for patients with NYHA class III/IV symptoms and patients 
      with SHF, the ICERs were $67 784 and $95 721 per QALY gained, respectively. Costs 
      per QALY gained were $101 120 for all patients, $72 501 for patients with SHF, 
      and $41 348 for patients with NYHA class III/IV symptoms. CONCLUSIONS: The 
      intervention was effective but costly to implement and did not reduce 
      utilization. It may not be cost-effective in other broadly representative samples 
      of patients. However, with program cost reductions and proper targeting, this 
      program may produce life-span increases at costs that are less than $100 000 per 
      QALY gained.
FAU - Smith, Brad
AU  - Smith B
AD  - Altarum Institute, 3737 Broadway, Ste 205, San Antonio, TX 78209, USA. 
      brad.smith@altarum.org
FAU - Hughes-Cromwick, Paul F
AU  - Hughes-Cromwick PF
FAU - Forkner, Emma
AU  - Forkner E
FAU - Galbreath, Autumn Dawn
AU  - Galbreath AD
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - Am J Manag Care
JT  - The American journal of managed care
JID - 9613960
MH  - Aged
MH  - Cost-Benefit Analysis
MH  - Diastole
MH  - *Disease Management
MH  - Female
MH  - Heart Failure/*economics/mortality
MH  - Humans
MH  - Male
MH  - Program Evaluation/economics
MH  - Prospective Studies
MH  - *Remote Consultation
MH  - Systole
MH  - *Telephone
EDAT- 2008/02/14 09:00
MHDA- 2008/03/08 09:00
CRDT- 2008/02/14 09:00
PHST- 2008/02/14 09:00 [pubmed]
PHST- 2008/03/08 09:00 [medline]
PHST- 2008/02/14 09:00 [entrez]
AID - 7020 [pii]
PST - ppublish
SO  - Am J Manag Care. 2008 Feb;14(2):106-15.