Is multidisciplinary care of heart failure cost-beneficial when combined with optimal medical care?

Authors


Abstract

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.

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