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Home-based management cost-effective for elderly patients with chronic HF
Care for elderly patients with chronic HF was more cost-effective when based out of the patient’s home rather than a specialized outpatient clinic, according to results from an Australian study.
The analysis included data from the WHICH trial, which included 280 elderly patients with chronic HF who were discharged after treatment at one of three tertiary hospitals in Australia. Researchers compared the cost-effectiveness of clinic-based intervention (n = 137) with home-based intervention (n = 143) during a median of 3.2 years of follow-up. Both intervention types included multidisciplinary care according to gold standard treatment, but home-based intervention took place primarily in the patient’s home and incorporated community-based care.
The cohort had a mean age of 71 years and was 73% men. Costs for both treatment types were reported in 2013 Australian dollars.
Mean total costs per group were AU$6.67 million with clinic-based intervention vs. AU$5.09 million with home-based intervention. Total costs were lower with home-based intervention, with a AU$13,100 decrease per patient compared with clinic-based care (P = .025). The researchers attributed this difference to a decrease in the length of all-cause hospital stay with home-based care (21 days vs. 32 days; P = .0006).
Patients had a mean of 2.5 life-years with clinic-based intervention compared with 2.9 life-years with home-based intervention, with mean quality-adjusted life-years of 1.8 and 2, respectively. Although the difference in life-years between groups was statistically significant (0.4 years; P = .02), the difference in quality-adjusted life-years was not (0.26 additional years per person with home-based care; P = .078).
Using a threshold of AU$50,000 for willingness-to-pay per quality-adjusted life-year, Maru and colleagues calculated a 96% probability that home-based intervention would be better-valued, with an incremental net monetary benefit of AU$24,342 (discounted 5% according to Australian health technology assessment guidelines).
Factors associated with net monetary benefit included home-based intervention (vs. clinic-based), fewer comorbidities, shorter HF duration, fewer HF-related hospitalizations within 1 year, no hyponatremia and a greater degree of patient confidence in their self-care.
“Ultimately, what matters may be the quality, structure, component and availability of the follow-up rather than the location of follow-up per se,” the researchers wrote. “If, however, the place of delivery, such as home, serves as a proxy of highly individualized care or a catalyst for changes needed to establish routines and patients’ automaticity, the location or setting in which care is delivered could be a key determinant of benefit.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.