Systematic review of trial-based analyses reporting the economic impact of heart failure management programs compared with usual care

Abstract

Background:

The cost-effectiveness of heart failure management programs (HF-MPs) is highly variable. We explored intervention and clinical characteristics likely to influence cost outcomes.

Methods:

A systematic review of economic analyses alongside randomized clinical trials comparing HF-MPs and usual care. Electronic databases were searched for English peer-reviewed articles published between 1990 and 2013.

Results:

Of 511 articles identified, 34 comprising 35 analyses met the inclusion criteria. Eighteen analyses (51%) reported a HF-MP as more effective and less costly; four analyses (11%), and five analyses (14%) also reported they were more effective but with no significant or an increased cost difference, respectively. Alternatively, five analyses (14%) reported no statistically significant difference in effects or costs, and one analysis (3%) reported no statistically significant effect difference but was less costly. Finally, two analyses (6%) reported no statistically significant effect difference but were more costly. Interventions that reduced hospital admissions tended to result in favorable cost outcomes, moderated by increased resource use, intervention cost and/or the durability of the intervention effect. The reporting quality of economic evaluation assessed by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist varied substantially between 5% and 91% (median 45%; 34 articles) of the checklist criteria adequately addressed. Overall, none of the study, patient or intervention characteristics appeared to independently influence the cost-effectiveness of a HF-MP.

Conclusion:

The extent that HF-MPs reduce hospital readmissions appears to be associated with favorable cost outcomes. The current evidence does not provide a sufficient evidence base to explain what intervention or clinical attributes may influence the cost implications.

Keywords

Heart failure disease management cost effectiveness economic evaluation healthcare expenditure hospitalization

Introduction

Heart failure (HF) is a costly disease with the majority of expenditure related to HF attributable to hospitalizations.^1,2 Thus, interventions that can either reduce hospital admissions or duration of stay will contribute significantly to reducing the cost of HF. The clinical benefit of multidisciplinary heart failure management programs (HF-MPs) has been demonstrated,^3–5 and such interventions have been widely recommended as a guideline-endorsed strategy across jurisdictions.^6–8 However, their value for money evaluated through cost-effectiveness analyses is complex and unclear. The cost implications depend on whether all costs for the intervention are accounted, the duration required for the intervention to produce and sustain the intended effects, and how the economic consequences of survival gain/loss are taken into account. Furthermore, the multi-component nature of these interventions and the context in which they are implemented make it even harder to determine which attribute of the intervention is more (or less) conducive to achieving intended effects.

In this systematic review we assess the economic evaluations undertaken alongside clinical trials of multi-component HF-MPs. The objectives of this study are to assess the cost-effectiveness of HF-MP compared with usual care, and to explore the intervention and clinical characteristics likely to influence cost outcomes.

Methods

The Preferred Reporting System for Systematic Reviews and Meta-Analysis (PRISMA) strategy was followed to ensure systematic selection of studies.⁹ Electronic databases (Medline, CINAHL, the NHS Economic Evaluations Database (NHS-EED)) were searched from January 1990–June 2013. Studies published before 1990 were not considered as it was not until 1995 that disease management appeared frequently in the medical literature.¹⁰ MeSH headings and keywords were used to identify trial-based analyses of HF-MPs reporting pre-specified cost outcomes. The complete search strategies are provided in Supplementary Material, Appendices 1–3.

Definition of HF-MP

The Taxonomy for Disease Management,¹¹ a system of classification developed by the American Heart Association (AHA), was used as the operational definition for a HF-MP. This taxonomy includes eight domains: patient population, recipient, intervention content, delivery personnel, method of communication, intensity and complexity, environment, and outcome measures. An intervention was deemed as a HF-MP if its description addressed all of these domains.

Study selection

Randomized controlled trials (RCTs) comparing a HF-MP with usual care were selected to ensure that observed net effects were more likely to be attributable to the intervention. Two reviewers independently screened the titles and abstracts of the identified citations according to exclusion and inclusion criteria (Table 1). Disagreements between reviewers were adjudicated by a third author. After the articles were excluded based on titles/abstracts, the full-texts of the remainder were reviewed using a screening algorithm (Table 2), namely, if an article met any of the conditions in Group A in the order listed, it was excluded. The remaining articles were further screened for the conditions in Group B, C and D. The algorithm was used to ensure only one reason for exclusion is assigned per article.

Table 1.

Inclusion and exclusion criteria.

Inclusion criteria	Exclusion criteria
(if all of the following met)	(if any of the following met)
1. Randomized controlled study	1. Studies not published in English.
2. Intervention was designed to manage or prevent HF using a systematic approach to care and employing multiple component intervention.	2. Design/protocol paper, methodological paper, (systematic) review, meta-analysis, and commentaries/editorial.
3. Intervention encompassed all eight domains specified by the AHA Taxonomy for Disease Management.¹¹	3. Key clinical endpoints were not HF-focused
4. Intervention was targeted at HF.	4. Cost outcomes not pre-specified
5. Intervention was compared against usual care	5. Insufficient information or effectiveness estimates not based on actual trial data (e.g. summarized effect).
6. Cost outcomes were pre-specified.	6. Cost-analyses based on modeled parameter
	7. Articles with the same hypothesis using the same population in the same RCT as those already included.

AHA: American Heart Association; HF: heart failure; RCT: randomized controlled trial.

Table 2.

Screening algorithm.

A	Not randomized controlled study
	Design/protocol only
	Methodological paper
	Review/meta-analysis
	Not HF focused
B	Cost outcomes not pre-specified
C	Not disease management
	Single intervention component
D	Insufficient/hypothetical information

HF: heart failure.

Selected studies were divided into full and partial economic evaluations. Full economic evaluation was defined as the studies that compared two or more alternatives, examined costs and consequences of the alternatives, and reported an incremental cost-effectiveness ratio (ICER) or an incremental cost-utility ratio (ICUR). Otherwise, a study was categorized as a partial economic evaluation (e.g. cost comparison, cost analysis).

Data extraction

A data collection table was developed a priori, pilot tested on three randomly-selected included articles, and refined accordingly. One reviewer extracted data on the study/intervention characteristics and details on economic evaluation. A second reviewer independently extracted data on 15 randomly selected studies for cross-checking to ensure accuracy. Any discrepancies between reviewers were resolved by discussion with a third author.

Cost outcomes were converted to 2013 US dollar values¹² (using purchasing power parity (PPP) conversion rates) and years (using gross domestic product (GDP) deflator index values).¹³ US dollars were used as a standard currency in preference to Euros (i.e. the PPP of the Euro varies widely across European countries making conversion to Euros using PPP highly variable. Use of US dollars avoids this problem).

Exposure variables

Most HF-MPs have a shared goal of improving mortality or hospitalisation, however, the reporting of interventions and measurement of costs can vary considerably. To standardize the ascertainment of intervention component and its intensity, the HF Disease Management Scoring Instrument (HF-DMSI)¹⁴ was used. The HF-DMSI incorporates six of the eight domains from the AHA taxonomy,¹¹ namely: recipient, intervention content, delivery personnel, method of communication, intensity/complexity, and environment.

For the purpose of this review, two domains of the HF-DMSI, ‘delivery personnel’ and ‘environment’ were adapted to increase the ability to differentiate observable intervention attributes (without reassigning weights). Under ‘delivery personnel’, originally categorized as [1] single generalist, [2] single HF expert, or [3] multidisciplinary, the last item ‘multidisciplinary’ was changed to the actual number of disciplines reported to be involved. This avoids making judgments as to what is ‘multidisciplinary’ or otherwise regardless of how it is named in an article. For ‘environment’, originally categorized as: [1] inpatient, [2] clinic/outpatient, [3] home-based, or [4] combination, the last item ‘combination’ was changed into listing the codes that applied. This shows the actual content of ‘combination’ (e.g. post-discharge clinic visit preceded by inpatient education is coded as [1,2]). Moreover, to discern a ‘home-based’ intervention involving healthcare providers’ home visits as a fundamental element from an intervention entirely telephonic, the former was coded as [3], the latter as [3x] (e.g. predominantly telephonic, home visits optional).

Data were also extracted on whether the information collected during the intervention was provided to patients’ treating physician or primary care physician, and when the first contact post-discharge was expected to occur.

Outcome variable

Cost outcomes were grouped into: (a) more effective/less costly (dominant), (b) more effective/more costly, (c) more effective/no statistically significant cost difference, (d) no statistically significant difference in effects or costs, (e) no statistically significant effect difference/less costly, and (f) no statistically significant effect difference/more costly. Total costs were computed as part of the review if sub-items were only reported in a disaggregated manner.

Clinical heterogeneity

Patients’ clinical characteristics: age, sex, NYHA, and background mortality as defined as the frequency of death observed in the usual care group were extracted. As the background mortality is expected to have fewer missing values than the NYHA, it is used as a proxy of disease severity across studies. Unless the incidence rate of death was explicitly reported for each arm, the number of deaths divided by the number of patients in the usual care arm is extracted to estimate the background mortality for each article, which was then annualized using the following equation,¹⁵ where p denotes the probability, r the rate and t the unit of time, respectively:

r = - \frac{1}{t} \ln (1 - p)

The resulting value was then converted to a one-year probability of death using the following equation:

p = 1 - e^{- n}

Study quality assessment

To assess the quality of reporting economic evaluations, we used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS checklist)¹⁶ by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). The CHEERS checklist consolidated previous health economic evaluation guidelines into one reporting guideline to help authors report economic evaluations or reviewers assess them for publication.¹⁶

Two reviewers independently assessed study quality using the checklist. Any discrepancies between reviewers were resolved by discussion with a third author. The CHEERS checklist consists of 24 items scored as having met the criteria in full (‘Yes’), not at all (‘No’) or not applicable. The items deemed to have partially met the criteria were scored as ‘No’ to avoid introducing subjectivity associated with assigning part scores. Although the CHEERS checklist is not a scoring instrument, study quality is expressed in percentages as a proportion of the items fully met for each article.

Results

Study characteristics

Of 511 articles retrieved, 34 articles were included in the final analysis (Figure 1).

Key clinical and economic items assessed in included articles are presented in Supplementary Material Table 1. The duration of follow-up ranged from three months to two years.

The source RCTs, that the economic analyses were based on, were conducted in: USA (n=16); Australia (n=4); Italy (n=4); the Netherlands (n=2); Spain (n=2); Sweden (n=2); Austria (n=1); Canada (n=1); Hong Kong (n=1); and Ireland (n=1). Some of the included articles shared the same RCT (Supplementary Material Table 1). For example: two articles from the USA, one a cost comparison¹⁷ and the other a cost-effectiveness analysis;¹⁸ two more from the USA, one an analysis on the full sample¹⁹ the other a sub-group;²⁰ two articles from Italy, one for the full sample²¹ and the other a stratified analysis.²² In addition, one article reported two analyses, for high- and low- intervention intensity (vs usual care).²³ Thus, there were 31 RCTs, with 35 analyses published in the 34 articles included.).

Patient characteristics

Across all trials, the age of the patients ranged from 56–83 years (mean age 72) and the percentage of female patients ranged from 1%–67% (mean 44%). The patients recruited at hospital discharge represented 82% (n=28 studies), community or outpatient-based patients represented 15% (n=5),^{17,18,24–26} and one article²⁷ reported a mixed population (66% recruited at hospital discharge; 34% from the clinician).

The mortality in the usual care group (background mortality) was reported in all but three articles.^18,19,28 Two^18,28 of those articles reported the rates for both arms combined, which was used as an approximation. The annualized background mortality rates ranged from 6%–48% (mean 22%); <20% (n=13 articles), >20% to <30% (n=12), >30% to <40% (n=5) and >40% (n=4).

Study components and its cost implications

Supplementary Material Table 2 details the intervention characteristics.

Usual care

The content of usual care was described in varying degrees of specificity. This ranged from merely stating ‘control’, ‘usual or routine care’,^17,29–38 minimal descriptions,^{18,19,21,23,24,26,39–42} to adequate descriptions of the content that comprised of usual care.^{20,25,27,43–47}

Timing of the first post-discharge contact with patients

The information on the scheduled contact with patients was not provided in six analyses as post-discharge interventions were not their focus (not applicable).^{17,18,24–26,30} Of those involving post-discharge interventions (n=29), the information was not reported (n=2),^35,37 contact scheduled within zero to three days (n=8),^{33,34,36,41,42,45,46,48} four to seven days (n=9),^{19–23,28,38,44,49} one to two weeks (n=8),^{29,31,32,39,40,43,47,50} and within two months (n=2).^23,27

Reporting of effectiveness

Of those which assessed all-cause death (n=16), four studies^17,18,26,29 found a statistically significant all-cause mortality benefit of HF-MPs. Of the 35 analyses, eight (23%) found no significant effect differences, and 27 (77%) reported statistically significant reductions in hospital admissions or mortality. There were no appreciable differences across the background mortality strata that may have led to those results.

Reporting of costs

Cost perspective

Cost perspectives included the healthcare system (n=8; 23%), payer (n=1; 3%), a third-party payer (n=1; 3%), both societal and payer (n=1; 3%) societal (n=2; 6%), and not explicitly stated (n=22; 63%) (Supplementary Material Table 1).

Costs of healthcare

The costs included in the analyses substantially varied in its scope and categorization. Costs for inpatient or outpatient resource use, medication, healthcare providers’ involvement, and intervention costs were reported in substantially differing forms. We were unable to determine whether the absence of certain information meant unmeasured, omitted, or such costs did not incur, and to map cost items across studies, such as ‘maintenance costs’, ‘informal care’, ‘home health aides’ or ‘start-up costs’.

Intervention costs

Intervention costs were included in cost comparisons in all except six articles (not reported n=2;^20,41 not included n=1;¹⁷ reported but not incorporated into between-group cost comparisons n=3).^28,49,50 Eight articles (24%) did not report actual amounts and/or net costs. Some of the ‘intervention’ was pertinent to a control group, yet in the cost breakdown, it was unclear as to what portion of the intervention cost was absorbed by the control group (22 articles; 61%).^{19,23
–25,27,31
–34,36,38,45,46} A net cost per person per duration was explicitly reported in 16 articles (47%).^{18,19,24,27,31
–34,36,38–40,43,45,46,48} Accordingly, intervention costs per person per month can be summarized as: mean US$120; median US$94; minimum US$21; max US$412 (in US dollar 2013 values).

Where intervention costs were mentioned (n=21, 62%), personnel costs (e.g. nurses) were reported the most (n=17; 47%). The other resources such as start-up, facilities, equipment, or supplies were mentioned only sporadically. It was unclear whether these costs were omitted because they were non-differential across the groups or the data were unavailable.

Discounting

No study with a follow-up longer than one year (n=8; 24%) discounted costs or benefits accrued after one year.

Cost comparison of HF-MPs vs usual care (partial economic evaluations; n=27)

Of 27 cost comparisons (i.e. no ICER/ICUR was reported), 14 articles (52%)^{19,21,25,28,32,33,36,39,40,44–47,50} reported HF-MPs as more effective/less costly; one article (4%)³¹ reported more effective/more costly results; four articles (15%)^17,41,42,49 reported more effective/no significant difference in costs; five articles (19%)^{20,30,37,38,48} found no statistically significant difference in effects or costs; one article (4%)³⁴ found no significant effect difference/less costly; and two articles (7%)^27,35 reported no significant effect difference /more costly.

Of those reporting a significant reduction in hospital admissions (all-cause or HF) (n=17), 13 (76%) reported cost reductions^{19,21,28,32,33,36,39,44–47,50} whereas four (24%) did not.^31,41,42,49 Of those reporting no significant difference in hospital admissions (n=6),^{20,27,30,35,38,48} none reported cost reductions.

Cost-effectiveness of HF-MPs vs usual care (full economic evaluation; n=8)

Eight analyses (7 articles) used an ICER (n=3) or ICUR (n=5). Costs were presented per QALY^{18,22
–24,26} (n=5), per life-year gained (LYG)²³ (n=1), per day survived²⁹ (n=1) and per readmission prevented⁴³ (n=1). These ICERs/ICURs are shown in US dollars and the figures as originally reported in articles (Supplementary Material Table 1).

Four HF-MPs^22,23,26,29 were shown to be dominant (more effective and less costly than usual care), two HF-MPs^24,43 were below a US$50,000 threshold (willingness to pay), whilst two HF-MPs cost US$182,138 per quality-adjusted life year (QALY)¹⁷ and US$70,449 per LYG,³¹ respectively (US dollars 2013). Of the seven analyses reporting a significant reduction in hospital admissions (all-cause or HF),^{22
–24,26,29,43} six (86%) found favorable cost outcomes whereas an ‘intensive’ intervention³¹ that involved contacts with nurse, home visits and multidisciplinary advice sessions cost US$70,449 per LYG (US dollars 2013).

Multidisciplinary approach (full and partial economic evaluations)

Eight analyses (23%) involved three or more disciplines, while 27 (77%) involved two or less (‘Delivery personnel’; Supplementary Material Table 2). Of the eight analyses (≥3 disciplines), seven reported HF-MPs as more effective (five were cost-saving,^{25,26,36,46,50} one cost neutral,⁴⁹ one more costly)²³ and one reported no significant benefits and less costly than usual care.³⁴ Of the 27 analyses (≤2 disciplines), 20 (74%) reported that HF-MPs improved outcomes,¹⁵ were cost-saving,^{19,21–24,28,29,32,33,39,40,43,44,47} two were more costly,^31,51 and three were cost neutral.^17,41,42 The remaining seven analyses (≤2 disciplines) reported no significant benefits; five found cost neutral,^{20,30,37,38,48} and two showed higher costs^27,35 than usual care.

Study quality assessed by the CHEERS Checklist

The reporting quality varied substantially from 5%–91% (median 45%; n=34). Among those reporting ICER/ICUR (n=7 articles), the variability was smaller, ranging from 41%–91% (median 82%).

The items that least complied with the CHEERS were the choice of discount rates used for costs and outcomes and its justification (item 9) (0% compliant of 8 applicable articles), estimating resources and costs (item 13) (19% compliant of 32 applicable articles), currency/price data (item 14) (21% compliant of 34 articles), and study parameter uncertainty (item 18) (19% compliant of 27 applicable articles). A requirement to characterize uncertainty (item 20) was significantly less likely to be addressed in partial evaluations (18%) than in the seven full economic evaluations (71%) (Supplementary Material Table 3).

Discussion

Of all 35 analyses (34 articles), 18 analyses (51%) reported a HF-MP as more effective and less costly than usual care, four of which were full economic evaluations. Our first objective was to assess whether HF-MPs are cost-effective. Among full economic evaluations of relatively comparable study quality (n=8 analyses), four interventions were dominant, two cost <US$50,000 per readmission averted and QALY, respectively, and two cost US$70,449 per LYG31 and US$182,138 per QALY,17 respectively (US dollars 2013). Among partial economic evaluations (n=27), the majority (52%, n=14) reported more effective/less costly results, followed by five (19%) reporting no statistically significant difference in effects or costs. Our second objective was to explore intervention or clinical characteristics likely to influence cost outcomes. However, substantial variability in the reporting of studies limited our ability to address this.

The extent of reduced hospital readmissions appeared to be associated with a favorable cost outcome. Of those reporting a significant reduction in hospital admissions (all-cause or HF), the majority (76%) reported HF-MPs as less costly, whereas, of those reporting no significant difference in admissions, no analyses (0%) reported cost reductions (vs usual care). This is unsurprising given that hospital activity accounts for the majority of the HF expenditure. However, the trend was less pronounced for the length of stay (LOS) in the hospital. Of 17 analyses assessing all-cause LOS, seven reported a significantly shorter LOS, of which six (86%) reported HF-MPs as less costly than usual care. Another 10 analyses showed no significant reduction in LOS, of which six (60%) reported HF-MPs as less costly nevertheless. This may imply that the re-admission itself influences cost outcomes more than LOS does as it is the initial period of stay that tends to incur the highest costs.

The economic benefits were offset in varying degrees by increased costs (costs of intervention, increased resource utilization) and the limited effect persistence. The durability of intervention effect determines whether additional costs are required to sustain the intended effect. Several articles reported such effects having waned during post-intervention periods, implying a need for a continued provision of intervention to maintain the benefits observed during the intervention duration (e.g. improved medication adherence,²⁵ reduced readmission rates,⁴⁶ reduced readmissions and hospital stay).^33,⁴⁶ An increase in resource utilization in the intervention group occurred in cardiovascular-related (n=1)²³ versus non-HF/cardiovascular-related activities (n=6).^{17,18,27,30,31,38} Such increases can occur if close monitoring, for example, causes patients to seek medical attention who would not otherwise do so and this monitoring does not lead to decreases in hospitalisation within the study follow-up.²⁷ Whether the early intervening efforts through HF-MPs reduce all-cause mortality/hospitalization in the long-term warrants attention given that comorbidities are prevalent among HF patients and yet RCTs rarely represent those sub-populations. The expectation for a future HF-MP may include an individualized approach based on various components involving not only care for HF but also comorbidities.⁵²

Our attempt to ascertain and compare the type/ intensity of HF-MPs and input/output costs across studies was undermined by the substantial variability in reporting. Very few studies provided sufficient information for readers to replicate or adjust the findings to their own settings. To make results comparable, the content, frequency or intensity of the intervention (and of usual care) must be detailed.

The majority of the analyses (n=27; 77%) conducted simple cost comparisons or cost-consequence analyses. Cost-consequence analyses report all costs and consequences in a separate and disaggregated way.⁵³ Although disaggregated reporting is a positive attribute, it also shifts the burden of interpretation and synthesis onto a reader.⁵³ Of 27 articles reporting an exact amount for the intervention cost, only 15 (55%) explicitly reported a net cost per person per period. This makes the burden even larger to users, left unable to replicate the findings. Practical tools such as the CHEERS,¹⁶ the HF-DMSI¹⁴ and the Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF) Costing Tool⁵⁴ can help increase transparency and comparability even when a simple cost comparison is conducted.

Limitations

Our analyses are descriptive due to the disparate nature and reporting of HF-MPs, which precluded statistical adjustments. Second, the presence of publication bias was not tested through a funnel plot as its asymmetry can be caused by true heterogeneity among studies itself,⁵⁵ which is highly probable in HF-MPs. Nevertheless, of the articles otherwise eligible only if they had reported pre-specified cost outcomes (n=41), 34 (83%) reported cost, which were included in our review, although we cannot deny the unpublished null findings of clinical effectiveness in the first place.

Conclusion

The extent of HF-MPs to reduce hospital readmissions appears to be associated with favorable cost outcomes moderated by intervention cost, increased resource use induced by the intervention and/or the durability of the intervention effect. The current evidence hinders rigorous analyses to inform the cost-effectiveness of HF-MPs and what intervention/clinical attributes may influence its cost implications. Although this does not negate the potential of certain HF-MPs being cost-effective, it remains difficult to determine its comparative value against alternative strategies unless further standardizations enable direct comparisons across studies. Increased transparency in reporting is urgently required.

Footnotes

Acknowledgements

Xanthe Golenko is acknowledged for assisting study selection. Sanjeewa Kularatna is acknowledged for assisting study quality assessment. Kylie Rixon is acknowledged for assisting data extraction.

Conflict of interest

None declared.

Funding

This work was supported by a National Health and Medical Research Council of Australia program grant (grant 519823) and in part by the Victorian Government’s Operational Infrastructure Support Program. MJC and SS are supported by the National Health and Medical Research Council of Australia.

Implications for practice

Given the substantial investments into care for heart failure, it is even more important to identify under what circumstances a HF-MP may provide the greatest efficiency to determine whether additional benefits justify such investment.

The extent and speed at which benefits wane over time is often unobserved. The assumed durability of the benefits beyond the end of the intervention can greatly affect the value for money of a HF-MP. With such uncertainty, decision-makers may wrongly decide not to invest in HF-MPs, or vice versa.

The key dimensions in a HF-MP must be clearly described. This will increase comparability across studies, such that intervention descriptions unequivocally inform what is supposed to happen, at what intensity and frequency, by whom, when and at what cost. This will enable cost-effective HF-MPs to be replicated in other settings.

References

Stewart

Jenkins

Buchan

. The current cost of heart failure to the National Health Service in the UK. Eur J Heart Fail 2002; 4: 361–371.

Berry

Murdoch

McMurray

. Economics of chronic heart failure. Eur J Heart Fail 2001; 3: 283–291.

Holland

Battersby

Harvey

. Systematic review of multidisciplinary interventions in heart failure. Heart 2005; 91: 899–906.

McAlister

Stewart

Ferrua

. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: A systematic review of randomized trials. J Am Coll Cardiol 2004; 44: 810–819.

McAlister

Lawson

Teo

. A systematic review of randomized trials of disease management programs in heart failure. Am J Med 2001; 110: 378–384.

Yancy

Jessup

Bozkurt

. 2013 ACCF/AHA Guideline for the Management of Heart Failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 62(16): e147–e239.

McMurray

Adamopoulos

Anker

. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787–1847.

National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Guidelines for the prevention, detection and management of chronic heart failure in Australia. July 2011. National Heart Foundation of Australia. http://www.heartfoundation.org.au/SiteCollectionDocuments/Chronic_Heart_Failure_Guidelines_2011.pdf (accessed 29 April 2014).

Moher

Liberati

Tetzlaff

. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Med 2009; 6: e1000097.

10.

Norris

Glasgow

Engelgau

. Chronic disease management: A definition and systematic approach to component interventions. Dis Management Health Outcomes 2003; 11: 477–88.

11.

Krumholz

Currie

Riegel

. A taxonomy for disease management: A scientific statement from the American Heart Association Disease Management Taxonomy Writing Group. Circulation 2006; 114: 1432–1445.

12.

Campbell and Cochrane Economics Methods Group and the Evidence for Policy and Practice Information and Coordinating Centre. CCEMG – EPPI-Centre Cost Converter (v.1.3), http://eppi.ioe.ac.uk/costconversion/default.aspx (accessed 22 August 2013).

13.

Shemilt

Thomas

Morciano

. A web-based tool for adjusting costs to a specific target currency and price year. Evid Policy 2010; 6: 51–59.

14.

Riegel

Lee

Sochalski

. Developing an instrument to measure heart failure disease management program intensity and complexity. Circ Cardiovasc Qual Outcomes 2010; 3: 324–330.

15.

Fleurence

Hollenbeak

. Rates and probabilities in economic modelling: Transformation, translation and appropriate application. Pharmacoeconomics 2007; 25: 3–6.

16.

Husereau

Drummond

Petrou

. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)–explanation and elaboration: A report of the ISPOR Health Economic Evaluations Publication Guidelines Task Force. Value Health 2013; 16: 231–250.

17.

Galbreath

Krasuski

Smith

. Long-term healthcare and cost outcomes of disease management in a large, randomized, community-based population with heart failure. Circulation 2004; 110: 3518–3526. (Errata appear in Circulation 2004; 110: 3615 and 2006; 113: e48.)

18.

Smith

Hughes-Cromwick

Forkner

. Cost-effectiveness of telephonic disease management in heart failure. Am J Manag Care 2008; 14: 106–115.

19.

Riegel

Carlson

Kopp

. Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Arch Intern Med 2002; 162: 705–712.

20.

Riegel

Carlson

Glaser

. Randomized controlled trial of telephone case management in Hispanics of Mexican origin with heart failure. J Card Fail 2006; 12: 211–219.

21.

Del Sindaco

Pulignano

Minardi

. Two-year outcome of a prospective, controlled study of a disease management programme for elderly patients with heart failure. J Cardiovasc Med (Hagerstown) 2007; 8: 324–329.

22.

Pulignano

Del Sindaco

Di Lenarda

. Usefulness of frailty profile for targeting older heart failure patients in disease management programs: A cost-effectiveness, pilot study. J Cardiovasc Med (Hagerstown) 2010; 11: 739–747.

23.

Postmus

Pari

AAA

Jaarsma

. A trial-based economic evaluation of 2 nurse-led disease management programs in heart failure. Am Heart J 2011; 162: 1096–1104.

24.

Hebert

Sisk

Wang

. Cost-effectiveness of nurse-led disease management for heart failure in an ethnically diverse urban community. Ann Intern Med 2008; 149: 540–548.

25.

Murray

Young

Hoke

. Pharmacist intervention to improve medication adherence in heart failure: A randomized trial. Ann Intern Med 2007; 146: 714–725.

26.

Capomolla

Febo

Ceresa

. Cost/utility ratio in chronic heart failure: Comparison between heart failure management program delivered by day-hospital and usual care. J Am Coll Cardiol 2002; 40: 1259–1266.

27.

Soran

Feldman

Pina

. Cost of medical services in older patients with heart failure: Those receiving enhanced monitoring using a computer-based telephonic monitoring system compared with those in usual care: The Heart Failure Home Care trial. J Card Fail 2010; 16: 859–866.

28.

Stewart

Vandenbroek

Pearson

. Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure. Arch Intern Med 1999; 159: 257–261.

29.

Adlbrecht

Huelsmann

Berger

. Cost analysis and cost-effectiveness of NT-proBNP-guided heart failure specialist care in addition to home-based nurse care. Eur J Clin Invest 2011; 41: 315–322.

30.

Copeland

Berg

Johnson

. An intervention for VA patients with congestive heart failure. Am J Manag Care 2010; 16: 158–165.

31.

Gregory

Kimmelstiel

Perry

. Hospital cost effect of a heart failure disease management program: The Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) trial. Am Heart J 2006; 151: 1013–1018.

32.

Krumholz

Amatruda

Smith

. Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. J Am Coll Cardiol 2002; 39: 83–89.

33.

Lopez Cabezas

Falces Salvador

Cubi Quadrada

. Randomized clinical trial of a postdischarge pharmaceutical care program vs regular follow-up in patients with heart failure. Farm. 2006; 30: 328–342.

34.

Patel

Shafazand

Ekman

. Home care as an option in worsening chronic heart failure – a pilot study to evaluate feasibility, quality adjusted life years and cost-effectiveness. Eur J Heart Fail 2008; 10: 675–681.

35.

Pugh

Havens

Xie

. Case management for elderly persons with heart failure: The quality of life and cost outcomes. MEDSURG Nursing 2001; 10: 71–78.

36.

Rich

Beckham

Wittenberg

. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 1995; 333: 1190–1195.

37.

Wootton

Gramotnev

Hailey

. A randomized controlled trial of telephone-supported care coordination in patients with congestive heart failure. J Telemed Telecare 2009; 15: 182–186.

38.

Kwok

Lee

Woo

. A randomized controlled trial of a community nurse-supported hospital discharge programme in older patients with chronic heart failure. J Clin Nurs 2008; 17: 109–117.

39.

Atienza

Anguita

Martinez-Alzamora

. Multicenter randomized trial of a comprehensive hospital discharge and outpatient heart failure management program. Eur J Heart Fail 2004; 6: 643–652.

40.

Cline

CMJ

Israelsson

BYA

Willenheimer

. Cost effective management programme for heart failure reduces hospitalisation. Heart 1998; 80: 442–446.

41.

Dunagan

Littenberg

Ewald

. Randomized trial of a nurse-administered, telephone-based disease management program for patients with heart failure. J Card Fail 2005; 11: 358–365.

42.

Kasper

Gerstenblith

Hefter

. A randomized trial of the efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmission. J Am Coll Cardiol 2002; 39: 471–480.

43.

Giordano

Scalvini

Zanelli

. Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure. Int J Cardiol 2009; 131: 192–199.

44.

de la Porte

PWFB-A

Lok

DJA

van Veldhuisen

. Added value of a physician-and-nurse-directed heart failure clinic: Results from the Deventer-Alkmaar heart failure study. Heart 2007; 93: 819–825.

45.

Ledwidge

Barry

Cahill

. Is multidisciplinary care of heart failure cost-beneficial when combined with optimal medical care? Eur J Heart Fail 2003; 5: 381–389.

46.

Naylor

Brooten

Campbell

. Transitional care of older adults hospitalized with heart failure: A randomized, controlled trial. J Am Geriatr Soc 2004; 52: 675–684. (Erratum appears in J Am Geriatr Soc 2004; 52:1228.)

47.

Tsuyuki

Fradette

Johnson

. A multicenter disease management program for hospitalized patients with heart failure. J Card Fail 2004; 10: 473–480.

48.

Laramee

Levinsky

Sargent

. Case management in a heterogeneous congestive heart failure population: A randomized controlled trial. Arch Intern Med 2003; 163: 809–817.

49.

Stewart

Pearson

Horowitz

. Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med 1998; 158: 1067–1072.

50.

Stewart

Marley

Horowitz

. Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with chronic congestive heart failure: A randomised controlled study. Lancet 1999; 354: 1077–1083.

51.

Smith

Kramer

Perrin

. A randomized trial of direct-to-patient communication to enhance adherence to beta-blocker therapy following myocardial infarction. Arch Intern Med 2008; 168: 477–483; discussion 83; quiz 47.

52.

Jaarsma

Strömberg

. Heart failure clinics are still useful (more than ever?). Can J Cardiol 2014; 30: 272–275.

53.

Gray

Clarke

Wolstenholme

. Applied methods of cost-effectiveness analysis in healthcare. New York: Oxford University Press, 2011.

54.

Reed

Kamble

. Introduction of the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Costing Tool: A user-friendly spreadsheet program to estimate costs of providing patient-centered interventions. Circ Cardiovasc Qual Outcomes 2012; 5: 113–119.

55.

Terrin

Schmid

Lau

. In an empirical evaluation of the funnel plot, researchers could not visually identify publication bias. J Clin Epidemiol 2005; 58: 894–901.

56.

Inglis

Pearson

Treen

. Extending the horizon in chronic heart failure: Effects of multidisciplinary, home-based intervention relative to usual care. Circulation 2006; 114: 2466–2473.

57.

Stewart

Horowitz

. Home-based intervention in congestive heart failure: Long-term implications on readmission and survival. Circulation 2002; 105: 2861–2866.

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