Tools for economic analysis of patient management interventions in heart failure cost-effectiveness model: a web-based program designed to evaluate the cost-effectiveness of disease management programs in heart failure

Autor: Barbara Riegel, Andrew Briggs, Matthew Gardner, David J. Whellan, Wayne C. Levy, Daniel Polsky, Matthew P. Neilson, Kevin A. Schulman, Felicia L. Graham, Sara C. Paul, Shelby D. Reed, Bradi B. Granger, Margaret Bowers, Yanhong Li
Jazyk: angličtina
Rok vydání: 2015
Předmět:
ISSN: 0002-8703
Popis: Background:\ud \ud Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable.\ud \ud Methods:\ud \ud We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics; use of evidence-based medications; and costs to generate predicted outcomes. Survival projections are based on a modified Seattle Heart Failure Model. Projections of resource use and quality of life are modeled using relationships with time-varying Seattle Heart Failure Model scores. The model can be used to evaluate parallel-group and single-cohort study designs and hypothetical programs. Simulations consist of 10,000 pairs of virtual cohorts used to generate estimates of resource use, costs, survival, and incremental cost-effectiveness ratios from user inputs.\ud \ud Results:\ud \ud The model demonstrated acceptable internal and external validity in replicating resource use, costs, and survival estimates from 3 clinical trials. Simulations to evaluate the cost-effectiveness of heart failure disease management programs across 3 scenarios demonstrate how the model can be used to design a program in which short-term improvements in functioning and use of evidence-based treatments are sufficient to demonstrate good long-term value to the health care system.\ud \ud Conclusion:\ud \ud The Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model provides researchers and providers with a tool for conducting long-term cost-effectiveness analyses of disease management programs in heart failure.\ud \ud Although economic evaluations of heart failure disease management programs are plentiful, a recent review identified only 2 formal cost-effectiveness analyses that extrapolated beyond a trial's follow-up period.1 Without extrapolation, the value of a disease management program may be underestimated. For example, an analysis of the South Texas Congestive Heart Failure Disease Management Project reported an incremental cost-effectiveness ratio >$100,000 per quality-adjusted life-year (QALY) within the trial's 18-month follow-up period.2 However, extension of the time horizon with a Markov model structured using New York Heart Association (NYHA) classification reduced the incremental cost-effectiveness ratio to >$50,000 per QALY.3 This example demonstrates the importance of accounting for all downstream costs and health benefits attributable to an intervention to provide a fair assessment of its cost-effectiveness.\ud \ud With support from the National Institute of Nursing Research, we developed user-friendly tools to facilitate high-quality economic evaluations of patient-focused interventions. In our project, Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF), we developed a costing tool4 and a cost-effectiveness model. In this article, we describe the TEAM-HF Cost-Effectiveness Model, a generalizable, Web-based tool designed to assist researchers, administrators, and providers in estimating short- or long-term estimates of resource use, costs, and cost-effectiveness of disease management programs or other care strategies in heart failure. We then compare predicted estimates of resource use and costs from the model to estimates from 3 studies to evaluate the internal and external validity of the model. We also evaluate the potential cost-effectiveness of 3 disease management scenarios to demonstrate how the model can be used to design more cost-effective interventions.
Databáze: OpenAIRE
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