© 2008 European Society of Cardiology
Decision-analytic evaluation of the clinical effectiveness and cost-effectiveness of management programmes in chronic heart failure
a Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School Boston, USA
b Division of Cardiology, Charité Campus Virchow-Klinikum Berlin, Germany
c Department for Public Health, Medical Decision Making and Health Technology Assessment, University for Health Science, Medical Informatics and Technology, Hall i.T. Austria
d Department of Health Policy and Management, Harvard School of Public Health Boston, USA
* Corresponding author. Cardiovascular Research Program, MGH Institute for Technology Assessment, Harvard Medical School, 101 Merrimac Street, 10th Floor, Boston, MA 02114-4724, USA. Tel.: +1 617 724 4445; fax: +1 617 726 9414. E-mail address: usiebert{at}hsph.harvard.edu (U. Siebert).
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Abstract |
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Background and aims: While management programmes (MPs) for chronic heart failure (CHF) are clinically effective, their cost-effectiveness remains uncertain. Thus, this study sought to determine the cost-effectiveness of MPs.
Methods and results: We developed a Markov model to estimate life expectancy, quality-adjusted life expectancy, lifetime costs, and the incremental cost-effectiveness of MPs as compared to standard care. Standard care was defined by the EuroHeart Failure Survey for Germany, MP efficacy was derived from our recent meta-analysis and cost estimates were based on the German healthcare system. For a population with a mean age 67 years (35% female) at onset of CHF, our model predicted an average quality-adjusted life expectancy of 2.64 years for standard care and 2.83 years for MP. MP yielded additional lifetime costs of 
1700 resulting in an incremental cost-utility ratio (ICUR) of 8900 (95% CI: dominant to 177,100) per quality-adjusted life year (QALY) gained. Sensitivity analyses demonstrated that the ICUR was sensitive to age and sex.
Conclusion: MPs increase life expectancy in patients with CHF by an average of 84 days and increase lifetime cost of care by approximately 1700. MPs improve outcomes in a cost-effective manner, although they are not cost-saving on a lifetime horizon.
Key Words: Hearth failure • Management programme • Cost-effectiveness analysis • Markov model
Received October 27, 2007; Revised April 30, 2008; Accepted July 24, 2008
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