Elsevier

American Heart Journal

Volume 170, Issue 5, November 2015, Pages 951-960
American Heart Journal

Clinical Investigation
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

https://doi.org/10.1016/j.ahj.2015.08.015Get rights and content

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Section snippets

Web-based application

To maximize accessibility, we developed a freely available Web-based tool that allows users to select modeling options and specify inputs in an integrated simulation model. The tool takes the form of a series of input pages (Table I). It includes 3 study design options: hypothetical scenario, parallel groups, and single cohort (Supplementary Figure A).

The hypothetical scenario design option allows the user to generate simulated outcomes for 2 patient groups with different clinical and treatment

CHIME

In CHIME, patients were hospitalized an average of 1.3 times, had 0.5 emergency department visits, and had 3.1 outpatient visits (Table II). By comparison, our model estimated 1.1 hospitalizations, 1.0 emergency department visits, and 13.9 outpatient visits. Mean total costs estimated using patient-level data from CHIME were similar to mean total costs estimated with the TEAM-HF model ($23,861 vs $23,621) when all levels of uncertainty were varied stochastically. When parameter estimates were

Discussion

The TEAM-HF Cost-Effectiveness Model provides a flexible tool for the research and clinical communities to evaluate the long-term cost-effectiveness of disease management programs in heart failure. In addition to facilitating formal cost-effectiveness analyses, the model can be used for budget planning, projecting hospitalization rates, and quantifying life expectancy for a cohort of patients over a period specified by the user. For example, the model could be used by health systems to predict

Disclosures

The University of Washington Center for Commercialization holds the copyright to the SHFM. Drs Schulman and Reed have made available online detailed listings of financial disclosures (www.dcri.duke.edu/research/coi.jsp).

Acknowledgements

Damon M. Seils, MA, Duke University, assisted with manuscript preparation.

References (28)

  • W.C. Levy et al.

    The Seattle Heart Failure Model: prediction of survival in heart failure

    Circulation

    (2006)
  • A.C. Alba et al.

    Risk prediction models for mortality in ambulatory patients with heart failure: a systematic review

    Circ Heart Fail

    (2013)
  • L. Tavazzi et al.

    Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial

    Lancet

    (2008)
  • J. Kjekshus et al.

    Rosuvastatin in older patients with systolic heart failure

    N Engl J Med

    (2007)
  • Cited by (6)

    Mark A. Hlatky, MD, served as guest editor for this article.

    View full text