Cost-Effectiveness of Specialized Multidisciplinary Heart Failure Clinics in Ontario, Canada

Authors

  • Harindra C. Wijeysundera MD,

    Corresponding author
    1. Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
    2. Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
    3. Department of Medicine, University of Toronto, Toronto, ON, Canada
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  • Márcio Machado PhD,

    1. Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
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  • Xuesong Wang MSc,

    1. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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  • Gabrielle Van Der Velde DC PhD,

    1. Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
    2. Institute for Work & Health, Toronto, ON, Canada
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  • Nancy Sikich MSc,

    1. Medical Advisory Secretariat, Ministry of Health and Long Term Care of Ontario, Toronto, ON, Canada
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  • William Witteman MIS,

    1. Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
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  • Jack V. Tu MD, PhD,

    1. Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
    2. Department of Medicine, University of Toronto, Toronto, ON, Canada
    3. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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  • Douglas S. Lee MD, PhD,

    1. Department of Medicine, University of Toronto, Toronto, ON, Canada
    2. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
    3. University Health Network—Toronto General Hospital, Toronto, ON, Canada
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  • Shaun G. Goodman MD, MSc,

    1. Department of Medicine, University of Toronto, Toronto, ON, Canada
    2. Canadian Heart Research Centre, Toronto, ON, Canada
    3. Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
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  • Robert Petrella MD, PhD,

    1. Department of Family Medicine, University of Western Ontario, Toronto, ON, Canada
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  • Martin O'Flaherty MD, MSc,

    1. Division of Public Health, University of Liverpool, Liverpool, UK
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  • Simon Capewell MD,

    1. Division of Public Health, University of Liverpool, Liverpool, UK
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  • Murray Krahn MD, MSc

    1. Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
    2. Department of Medicine, University of Toronto, Toronto, ON, Canada
    3. Canadian Heart Research Centre, Toronto, ON, Canada
    4. Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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Harindra C. Wijeysundera, 2075 Bayview Avenue, Suite A209D, Toronto, ON, Canada M4N 3M5. E-mail: wijeysundera@gmail.com

ABSTRACT

Background:  Specialized multidisciplinary clinics have been shown to reduce mortality in heart failure (HF). Our objective was to evaluate the cost-effectiveness of this model of care delivery.

Methods:  We performed a cost-effectiveness analysis, with a 12-year time horizon, from the perspective of the Ontario Ministry of Health and Long-term Care, comparing a standard care cohort, consisting of all patients admitted to hospital with HF in 2005, to a hypothetical cohort treated in HF clinics. Survival curves describing the natural history of HF were constructed using mortality estimates from the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. Survival benefits and resource uptake associated with HF clinics were estimated from a meta-analysis of published trials. HF clinics costs were obtained by costing a representative clinic in Ontario. Health-related costs were determined through linkage to administrative databases. Outcome measures included life expectancy (years), costs (in 2008 Canadian dollars) and the incremental cost-effectiveness ratio (ICER).

Results:  HF clinics were associated with a 29% reduction in all-cause mortality (risk ratio [RR] 0.71; 95% confidence interval [CI] 0.56–0.91) but a 12% increase in hospitalizations (RR 1.12; 95% CI 0.92–1.135). The cost of care in HF clinics was $52 per 30 patient-days. Projected life-expectancy of HF clinic patients was 3.91 years, compared to 3.21 years for standard care. The 12-year cumulative cost per patient in the HF clinic group was $66,532 versus $53,638 in the standard care group. The ICER was $18,259/life-year gained.

Conclusions:  HF clinics appear to be a cost effective way of delivering ambulatory care to HF patients.

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