© 2003 European Society of Cardiology
Is multidisciplinary care of heart failure cost-beneficial when combined with optimal medical care?
a Heart Failure Unit, St Vincent's University Hospital Elm Park, Dublin 4, Ireland
b National Centre for Pharmacoeconomics, St James's Hospital Dublin 8, Ireland
* Corresponding author. Tel.: +353-1-2094147; fax: +353-1-2094149. E-mail address: kenneth.mcdonald{at}ucd.ie
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Abstract |
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Background: Multidisciplinary care (MDC) of heart failure (HF) can significantly reduce rates of unplanned hospitalisation, the major cost component of HF care.
Aims: This prospective, randomised, controlled study examines the cost-benefits of MDC of HF in the setting of optimal medical care.
Methods: 98 NYHA class IV HF patients (mean age 70.8±10.5 years) were randomised to MDC (n=51) or routine care (RC; n=47) of HF. A direct intervention cost was calculated from contact time (scheduled and unscheduled) spent by the MDC team. Unplanned hospitalisation costs for HF were calculated at a daily rate of 
242. Outcomes were determined in monetary terms, i.e. the cost of the service per hospitalisation prevented and net costs/savings at 3 months.
Results: The direct intervention cost of the MDC team was 5860, with an average cost per patient of 113 (95% Cl: 97–128). At 3 months, there were a total of 12 unplanned HF readmissions in the RC group (25.5% rate, 195 days) compared to 2 in the MDC group (3.9% rate, 17 days). The number needed to treat to prevent one hospitalisation for HF was 6 over 3 months. The cost of the service per hospitalisation prevented was 586. The intervention produced a net cost saving of 37,216 for 51 patients treated over 3 months. Sensitivity analyses using 50% variation in costs and lower relative risk reductions confirmed the cost-benefits of the intervention.
Conclusion: MDC of HF remains cost-beneficial when combined with optimal, medical care. The significant clinical and cost-benefits suggest that this intensive approach to MDC and medical management should become the standard of care for HF.
Key Words: Heart failure • Multidisciplinary care • Health economic evaluation
Received January 3, 2002; Revised September 9, 2002; Accepted October 14, 2002
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