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Zakiyah N, Marulin D, Alfaqeeh M, Puspitasari IM, Lestari K, Lim KK, Fox-Rushby J. Economic Evaluations of Digital Health Interventions for Patients With Heart Failure: Systematic Review. J Med Internet Res 2024; 26:e53500. [PMID: 38687991 PMCID: PMC11094606 DOI: 10.2196/53500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have shown promising results in enhancing the management of heart failure (HF). Although health care interventions are increasingly being delivered digitally, with growing evidence on the potential cost-effectiveness of adopting them, there has been little effort to collate and synthesize the findings. OBJECTIVE This study's objective was to systematically review the economic evaluations that assess the adoption of DHIs in the management and treatment of HF. METHODS A systematic review was conducted using 3 electronic databases: PubMed, EBSCOhost, and Scopus. Articles reporting full economic evaluations of DHIs for patients with HF published up to July 2023 were eligible for inclusion. Study characteristics, design (both trial based and model based), input parameters, and main results were extracted from full-text articles. Data synthesis was conducted based on the technologies used for delivering DHIs in the management of patients with HF, and the findings were analyzed narratively. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. The reporting quality of the included studies was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. RESULTS Overall, 27 economic evaluations were included in the review. The economic evaluations were based on models (13/27, 48%), trials (13/27, 48%), or a combination approach (1/27, 4%). The devices evaluated included noninvasive remote monitoring devices (eg, home telemonitoring using digital tablets or specific medical devices that enable transmission of physiological data), telephone support, mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems. Most of the studies (24/27, 89%) used cost-utility analysis. The majority of the studies (25/27, 93%) were conducted in high-income countries, particularly European countries (16/27, 59%) such as the United Kingdom and the Netherlands. Mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems yielded cost-effective results or even emerged as dominant strategies. However, conflicting results were observed, particularly in noninvasive remote monitoring devices and telephone support. In 15% (4/27) of the studies, these DHIs were found to be less costly and more effective than the comparators (ie, dominant), while 33% (9/27) reported them to be more costly but more effective with incremental cost-effectiveness ratios below the respective willingness-to-pay thresholds (ie, cost-effective). Furthermore, in 11% (3/27) of the studies, noninvasive remote monitoring devices and telephone support were either above the willingness-to-pay thresholds or more costly than, yet as effective as, the comparators (ie, not cost-effective). In terms of reporting quality, the studies were classified as good (20/27, 74%), moderate (6/27, 22%), or excellent (1/27, 4%). CONCLUSIONS Despite the conflicting results, the main findings indicated that, overall, DHIs were more cost-effective than non-DHI alternatives. TRIAL REGISTRATION PROSPERO CRD42023388241; https://tinyurl.com/2p9axpmc.
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Affiliation(s)
- Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Dita Marulin
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Mohammed Alfaqeeh
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Irma Melyani Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Keri Lestari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Ka Keat Lim
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Julia Fox-Rushby
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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Reinhardt SW, Clark KA, Xin X, Parzynski CS, Riello RJ, Sarocco P, Ahmad T, Desai NR. Thirty-Day and 90-Day Episode of Care Spending Following Heart Failure Hospitalization Among Medicare Beneficiaries. Circ Cardiovasc Qual Outcomes 2022; 15:e008069. [DOI: 10.1161/circoutcomes.121.008069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Despite growing interest in value-based models, utilization patterns and costs for heart failure (HF) admissions are not well understood. We sought to characterize Medicare spending for patients with HF for 30- and 90-day episodes of care (which include an index hospitalization and 30 or 90 days following discharge) and to describe the patterns of post-acute care spending.
METHODS:
Using Medicare fee-for-service administrative claims data from 2016 to 2018, we performed a retrospective analysis of patients discharged after hospitalization with primary discharge diagnoses of systolic HF, diastolic HF, hypertensive heart disease (HHD) with HF, and HHD with HF and chronic kidney disease. We analyzed coding patterns across these groups over time, median 30- and 90-day payments, and costs allocated to index hospitalization and postacute care.
RESULTS:
The study included 935 962 patients discharged following hospitalization for HF (systolic HF: 178 603; diastolic HF: 165 156; HHD with HF: 226 929; HHD with HF and chronic kidney disease: 365 274). The proportion of HHD codes increased from 26% of HF hospitalizations in 2016 to 91% in 2018. There was substantial spending on 30-day (median $13 330, interquartile range $9912–$22 489) and 90-day episodes (median $21 658, interquartile range $12 423–$37 630) for HF with significant variation, such that the third quartile of patients incurred costs 3 times the amount of the first quartile. Across all codes, the index hospitalization accounted for ≈70% of 30-day and 45% of 90-day spending. Sixty-one percent of postacute care spending occurred 31 to 90 days following discharge, with readmissions and observation stays (36%) and skilled nursing facilities (27%) comprising the largest categories.
CONCLUSIONS:
This patient episode-level analysis of contemporary Medicare beneficiaries is the first to examine 90-day spending, which will become an increasingly important pasyment benchmark with the expansion of the Medicare Bundled Payments for Care Improvement Program. Further investigation into the drivers of costs will be essential to provide high-value HF care.
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Affiliation(s)
- Samuel W. Reinhardt
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.W.R., K.A.A.C., T.A., N.R.D.)
| | - Katherine A.A. Clark
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.W.R., K.A.A.C., T.A., N.R.D.)
| | - Xin Xin
- Center for Outcomes Research & Evaluationm Yale-New Haven Hospital, New Haven‚ CT. (X.X., C.S.P., T.A., N.R.D.)
| | - Craig S. Parzynski
- Center for Outcomes Research & Evaluationm Yale-New Haven Hospital, New Haven‚ CT. (X.X., C.S.P., T.A., N.R.D.)
| | - Ralph J. Riello
- Department of Pharmacy, Yale-New Haven Hospital, New Haven‚ CT. (R.J.R.)
| | - Phil Sarocco
- Cytokinetics, Incorporated, South San Francisco, CA (P.S.)
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.W.R., K.A.A.C., T.A., N.R.D.)
- Center for Outcomes Research & Evaluationm Yale-New Haven Hospital, New Haven‚ CT. (X.X., C.S.P., T.A., N.R.D.)
| | - Nihar R. Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.W.R., K.A.A.C., T.A., N.R.D.)
- Center for Outcomes Research & Evaluationm Yale-New Haven Hospital, New Haven‚ CT. (X.X., C.S.P., T.A., N.R.D.)
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Bocchi EA, Moreira HT, Nakamuta JS, Simões MV. Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers. Clinics (Sao Paulo) 2021; 76:e1991. [PMID: 33503176 PMCID: PMC7798368 DOI: 10.6061/clinics/2021/e1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/15/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.
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Affiliation(s)
- Edimar Alcides Bocchi
- Nucleo de Insuficiencia Cardiaca, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Henrique Turin Moreira
- Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | | | - Marcus Vinicius Simões
- Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
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Joynt Maddox K, Bleser WK, Crook HL, Nelson AJ, Hamilton Lopez M, Saunders RS, McClellan MB, Brown N. Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative. Circ Cardiovasc Qual Outcomes 2020; 13:e006483. [PMID: 32393125 DOI: 10.1161/circoutcomes.120.006483] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart failure (HF) is a leading cause of hospitalizations and readmissions in the United States. Particularly among the elderly, its prevalence and costs continue to rise, making it a significant population health issue. Despite tremendous progress in improving HF care and examples of innovation in care redesign, the quality of HF care varies greatly across the country. One major challenge underpinning these issues is the current payment system, which is largely based on fee-for-service reimbursement, leads to uncoordinated, fragmented, and low-quality HF care. While the payment landscape is changing, with an increasing proportion of all healthcare dollars flowing through value-based payment models, no longitudinal models currently focus on chronic HF care. Episode-based payment models for HF hospitalization have yielded limited success and have little ability to prevent early chronic disease from progressing to later stages. The available literature suggests that primary care-based longitudinal payment models have indirectly improved HF care quality and cardiovascular care costs, but these models are not focused on addressing patients' longitudinal chronic disease needs. This article describes the efforts and vision of the multi-stakeholder Value-Based Models Learning Collaborative of The Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. The Learning Collaborative developed a framework for a HF value-based payment model with a longitudinal focus on disease management (to reduce adverse clinical outcomes and disease progression among patients with stage C HF) and prevention (an optional track to prevent high-risk stage B pre-HF from progressing to stage C). The model is designed to be compatible with prevalent payment models and reforms being implemented today. Barriers to success and strategies for implementation to aid payers, regulators, clinicians, and others in developing a pilot are discussed.
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Affiliation(s)
- Karen Joynt Maddox
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, and Center for Health Economics and Policy, Institute for Public Health at Washington University, St. Louis, MO (K.J.M.)
| | - William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Hannah L Crook
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Adam J Nelson
- Duke Clinical Research Institute, Duke University, Durham, NC (A.J.N.)
| | - Marianne Hamilton Lopez
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Robert S Saunders
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Mark B McClellan
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Nancy Brown
- American Heart Association, Dallas, TX (N.B.)
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Grund S, Bauer J, Schuler M. [Post-acute geriatric rehabilitation outcomes in fracture patients treated in an orthogeriatric trauma center-A prospective investigation with historical control]. Z Gerontol Geriatr 2020; 53:564-571. [PMID: 32367172 DOI: 10.1007/s00391-020-01727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the increasing amount of positive evidence with respect to mortality for the orthogeriatric co-management in a center for geriatric traumatology (CGT), effects on the course after the acute inpatient hospital treatment have been insufficiently investigated. METHODS Patients over 75 years old who needed rehabilitation following acute inpatient treatment before (retrospective, n = 90) and after (prospective, n = 99) the introduction of a certified CGT were investigated. The two groups were compared with respect to the frequency of discharge into an indication-specific (AHB) and geriatric rehabilitation, mobility performance including the five times sit-to-stand test, short physical performance battery (SPPB) and competence in activities of daily living with the Barthel index (BI). RESULTS After introduction of a CGT 17.2% (95 % confidence interval [95 % CI]: 10-25%; p < 0.027) of the patients were discharged to a specialized orthopedic inpatient rehabilitation (AHB) vs. 6.7% (95 % CI: 1-12%) before the introduction. Correspondingly less patients needed geriatric rehabilitation (before CGT 93.3 %, 95 % CI: 88.1-98.6 vs. CGT 82.8 %, 95 % CI: 75-90; p < 0.001). The overall outcome of post-acute geriatric inpatient rehabilitation improved in both groups but did not differ. Patients who needed two therapy sessions in the CGT were clearly poorer than those with one therapy session with respect to activities of daily living (BI: 34.1, 95 % CI: 30-37.2 vs. 41.2, 95 % CI: 30.9-51.4) and mobility performance (SPPB: 1.2, 95 % CI: 0.7-1.8 vs. 2.2, 95 % CI: 0.9-3.4; p = 0.048). The differences remained despite improvement of both groups during geriatric rehabilitation. CONCLUSION The establishment of a CGT enables more patients to be discharged into a less cost-intensive AHB. The more intensive treatment in the CGT offers more severely affected patients the chance for further functional improvement through post-acute inpatient geriatric rehabilitation. A predominantly closing treatment of patients in a CGT is not conceivable in the CGT model presented.
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Affiliation(s)
- Stefan Grund
- Geriatrisches Zentrum Heidelberg, Universität Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland. .,Abteilung für Geriatrie und Geriatrische Rehabilitation, Agaplesion Bethanien Krankenhaus Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland.
| | - Jürgen Bauer
- Geriatrisches Zentrum Heidelberg, Universität Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland.,Abteilung für Geriatrie und Geriatrische Rehabilitation, Agaplesion Bethanien Krankenhaus Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland
| | - Matthias Schuler
- Diakonissen Krankenhaus Mannheim Abteilung für Geriatrie, Speyerer Straße 91-93, 68163, Mannheim, Deutschland
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Zanjani F, Schoenberg N, Martin C, Clayton R. Reducing Medication Risks in Older Adult Drinkers. Gerontol Geriatr Med 2020; 6:2333721420910936. [PMID: 32166107 PMCID: PMC7052447 DOI: 10.1177/2333721420910936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/03/2019] [Accepted: 02/11/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: Prevalent concomitant alcohol and medication use among older
adults is placing this group at risk for adverse health events. Given limited existing
interventions to address concomitant alcohol and medication risk (AMR), a brief
educational intervention was demonstrated. The purpose of the current study was to examine
change in AMR behaviors 3 months post-education among older adult drinkers.
Methods: A convenience sample of 58 older adult drinkers (mean age = 72)
was recruited and followed (n = 40; 70% at follow-up), from four
pharmacies in rural Virginia. Results: Findings indicated decreased alcohol
consumption in high-risk drinkers. Conclusion: Future research should explore
methods to sustain reduced AMR.
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Affiliation(s)
| | | | | | - Richard Clayton
- University of Kentucky College of Public Health, Lexington, USA
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Rich MW. To Invest or Divest - Tough Choices in the Wake of VEST. J Card Fail 2018; 24:625-626. [PMID: 30447850 DOI: 10.1016/j.cardfail.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Michael W Rich
- Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8086, St. Louis, MO 63110.
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Thangam M, Joynt Maddox KE. Adequate Evidence, Inadequate Incentives for Disease Management Programs. J Card Fail 2018; 24:638-639. [PMID: 30308240 DOI: 10.1016/j.cardfail.2018.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 09/30/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Manoj Thangam
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, Saint Louis, Missouri
| | - Karen E Joynt Maddox
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, Saint Louis, Missouri.
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