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Specialized intervention cost-effective for chronic liver disease

Specialized chronic disease management for patients with chronic liver disease demonstrated high potential to be more cost-effective than standard care due to fewer patient deaths, according to recently published data.

“The management of chronic liver failure (CLF) remains a significant challenge for health systems worldwide due to the high prevalence of the condition and disease complexity, resulting in frequent readmissions and associated substantial economic impacts,” Alan J. Wigg, PhD, FRACP, from the Flinders Medical Centre, Australia, and colleagues wrote. “This contrasts with many other chronic diseases, where chronic disease management (CDM) principles have been successfully applied.”

The CDM model designed by Wigg and colleagues consisted of coordinated case management with a multidisciplinary medical team, weekly follow-ups after discharge, rapid access to care via phone, appointment reminders, enhanced patient and caretaker education on self-management, and individual patient data sheets with information on risk factors and medications.

To compare the relative cost effectiveness of the CDM model with standard care, the researchers randomly assigned 40 patients to receive intervention and 20 to receive standard care. A senior hepatology nurse was the predominant administrator of intervention for 12 months.

After 1 year, the researchers initiated CDM care for patients who started with standard care while the CDM cohort continued to receive specialized management for another 12 months.

During the initial 12-month trial, patients in the CDM cohort had higher total costs compared with those who received standard care (difference, $18,521; 95% CI, 1,722-44,434). At 24 months, the CDM cohort had lower total costs compared with those who started with standard care (difference, –$19,506; 95% CI, –59,335 to 6,009).

Data analysis after the first 12 months showed that the CDM model would result in five avoided deaths per 100 cases. After 24 months, analysis showed that the CDM model would result in 12 avoided deaths per 100 cases.

The researchers found that the CDM model had a 70% probability of being more cost-effective than standard care at willingness to pay approximately $400,000 per additional avoided death and $40,000 per unit improvement in Chronic Liver Disease Questionnaire (CLDQ) score, based on 12-month data. With data available from 24 months, the probability of the CDM model being more cost-effective was 80% at willingness to pay $150,000 per additional avoided death.

“Reassuringly, hospitalization costs for intervention patients decreased by 32% below baseline costs and 55% below the initial year of intervention during the second year of CDM intervention. Indeed annual hospitalization costs per participant for intervention patients continued to be maintained below baseline costs for a further 3 years beyond the period of this study,” the researchers wrote. “It seems plausible, therefore, that higher ‘upfront’ cost may be required in the first year of CDM to both stabilize and rescue sick patients and to achieve cost savings in subsequent years.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.