The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: a decision model-based analysis

on behalf of the REACH-HF investigators, Rod S . Taylor (Lead / Corresponding author), Susannah Sadler, Hasnain M. Dalal, Fiona C. Warren, Kate Jolly, Russell Davis, Patrick Doherty, Jackie Miles, Colin J. Greaves, Jennifer Wingham, Melvyn Hillsdon, Charles Abraham, Julia Frost, Sally Singh, Christopher Hayward, Victoria Eyre, Kevin Paul, Chim Lang, Karen Smith

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Abstract

Background: The REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) trial found that the REACH-HF home-based cardiac rehabilitation intervention resulted in a clinically meaningful improvement in disease-specific health-related quality of life in patients with reduced ejection fraction heart failure (HFrEF). The aims of this study were to assess the long-term cost-effectiveness of the addition of REACH-HF intervention or home-based cardiac rehabilitation to usual care compared with usual care alone in patients with HFrEF. Design and methods: A Markov model was developed using a patient lifetime horizon and integrating evidence from the REACH-HF trial, a systematic review/meta-analysis of randomised trials, estimates of mortality and hospital admission and UK costs at 2015/2016 prices. Taking a UK National Health and Personal Social Services perspective we report the incremental cost per quality-adjusted life-year (QALY) gained, assessing uncertainty using probabilistic and deterministic sensitivity analyses. Results: In base case analysis, the REACH-HF intervention was associated with per patient mean QALY gain of 0.23 and an increased mean cost of £400 compared with usual care, resulting in a cost per QALY gained of £1720. Probabilistic sensitivity analysis indicated a 78% probability that REACH-HF is cost effective versus usual care at a threshold of £20,000 per QALY gained. Results were similar for home-based cardiac rehabilitation versus usual care. Sensitivity analyses indicate the findings to be robust to changes in model assumptions and parameters. Conclusions: Our cost-utility analyses indicate that the addition of the REACH-HF intervention and home-based cardiac rehabilitation programmes are likely to be cost-effective treatment options versus usual care alone in patients with HFrEF.

Original languageEnglish
Number of pages10
JournalEuropean Journal of Preventive Cardiology
Early online date18 Mar 2019
DOIs
Publication statusE-pub ahead of print - 18 Mar 2019

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Cost-Benefit Analysis
Rehabilitation
Heart Failure
Quality-Adjusted Life Years
Costs and Cost Analysis
Cardiac Rehabilitation
Hospital Mortality
Social Work
Health Care Costs
Uncertainty
Meta-Analysis
Quality of Life
Health

Keywords

  • Cardiac rehabilitation
  • cost-effectiveness
  • decision model
  • health-related quality of life
  • heart failure
  • home-based

Cite this

on behalf of the REACH-HF investigators ; Taylor, Rod S . ; Sadler, Susannah ; Dalal, Hasnain M. ; Warren, Fiona C. ; Jolly, Kate ; Davis, Russell ; Doherty, Patrick ; Miles, Jackie ; Greaves, Colin J. ; Wingham, Jennifer ; Hillsdon, Melvyn ; Abraham, Charles ; Frost, Julia ; Singh, Sally ; Hayward, Christopher ; Eyre, Victoria ; Paul, Kevin ; Lang, Chim ; Smith, Karen. / The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction : a decision model-based analysis. In: European Journal of Preventive Cardiology. 2019.
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title = "The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: a decision model-based analysis",
abstract = "Background: The REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) trial found that the REACH-HF home-based cardiac rehabilitation intervention resulted in a clinically meaningful improvement in disease-specific health-related quality of life in patients with reduced ejection fraction heart failure (HFrEF). The aims of this study were to assess the long-term cost-effectiveness of the addition of REACH-HF intervention or home-based cardiac rehabilitation to usual care compared with usual care alone in patients with HFrEF. Design and methods: A Markov model was developed using a patient lifetime horizon and integrating evidence from the REACH-HF trial, a systematic review/meta-analysis of randomised trials, estimates of mortality and hospital admission and UK costs at 2015/2016 prices. Taking a UK National Health and Personal Social Services perspective we report the incremental cost per quality-adjusted life-year (QALY) gained, assessing uncertainty using probabilistic and deterministic sensitivity analyses. Results: In base case analysis, the REACH-HF intervention was associated with per patient mean QALY gain of 0.23 and an increased mean cost of £400 compared with usual care, resulting in a cost per QALY gained of £1720. Probabilistic sensitivity analysis indicated a 78{\%} probability that REACH-HF is cost effective versus usual care at a threshold of £20,000 per QALY gained. Results were similar for home-based cardiac rehabilitation versus usual care. Sensitivity analyses indicate the findings to be robust to changes in model assumptions and parameters. Conclusions: Our cost-utility analyses indicate that the addition of the REACH-HF intervention and home-based cardiac rehabilitation programmes are likely to be cost-effective treatment options versus usual care alone in patients with HFrEF.",
keywords = "Cardiac rehabilitation, cost-effectiveness, decision model, health-related quality of life, heart failure, home-based",
author = "{on behalf of the REACH-HF investigators} and Taylor, {Rod S .} and Susannah Sadler and Dalal, {Hasnain M.} and Warren, {Fiona C.} and Kate Jolly and Russell Davis and Patrick Doherty and Jackie Miles and Greaves, {Colin J.} and Jennifer Wingham and Melvyn Hillsdon and Charles Abraham and Julia Frost and Sally Singh and Christopher Hayward and Victoria Eyre and Kevin Paul and Chim Lang and Karen Smith",
note = "Funding: This work was supported by the United Kingdom’s National Institute for Health Research (NIHR) Programme Grants for Applied Research [grant number RP-PG-1210-12004]. Professors Taylor and Britten are part-funded by the National Institute for Health Research (NIHR) Collaboration for Peninsula Leadership in Applied Health Research and Care. Professor Jolly is part-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands. Professor Britten is part-funded by the NIHR CLAHRC South West Peninsula. Professor Singh is supported by NIHR CLARCH East Midlands. The funders’ peer-review process informed the trial protocol. The sponsor of the trial had no role in trial design, data collection, data analysis, data interpretation, or writing of the report. The views expressed in this publication are those of the authors and not necessarily of the NIHR or United Kingdom’s Department of Health and Social Care.",
year = "2019",
month = "3",
day = "18",
doi = "10.1177/2047487319833507",
language = "English",
journal = "European Journal of Preventive Cardiology",
issn = "2047-4873",
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on behalf of the REACH-HF investigators, Taylor, RS, Sadler, S, Dalal, HM, Warren, FC, Jolly, K, Davis, R, Doherty, P, Miles, J, Greaves, CJ, Wingham, J, Hillsdon, M, Abraham, C, Frost, J, Singh, S, Hayward, C, Eyre, V, Paul, K, Lang, C & Smith, K 2019, 'The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: a decision model-based analysis' European Journal of Preventive Cardiology. https://doi.org/10.1177/2047487319833507

The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction : a decision model-based analysis. / on behalf of the REACH-HF investigators; Taylor, Rod S . (Lead / Corresponding author); Sadler, Susannah ; Dalal, Hasnain M. ; Warren, Fiona C. ; Jolly, Kate; Davis, Russell; Doherty, Patrick; Miles, Jackie ; Greaves, Colin J.; Wingham, Jennifer; Hillsdon, Melvyn ; Abraham, Charles; Frost, Julia ; Singh, Sally ; Hayward, Christopher; Eyre, Victoria ; Paul, Kevin ; Lang, Chim; Smith, Karen.

In: European Journal of Preventive Cardiology, 18.03.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction

T2 - a decision model-based analysis

AU - on behalf of the REACH-HF investigators

AU - Taylor, Rod S .

AU - Sadler, Susannah

AU - Dalal, Hasnain M.

AU - Warren, Fiona C.

AU - Jolly, Kate

AU - Davis, Russell

AU - Doherty, Patrick

AU - Miles, Jackie

AU - Greaves, Colin J.

AU - Wingham, Jennifer

AU - Hillsdon, Melvyn

AU - Abraham, Charles

AU - Frost, Julia

AU - Singh, Sally

AU - Hayward, Christopher

AU - Eyre, Victoria

AU - Paul, Kevin

AU - Lang, Chim

AU - Smith, Karen

N1 - Funding: This work was supported by the United Kingdom’s National Institute for Health Research (NIHR) Programme Grants for Applied Research [grant number RP-PG-1210-12004]. Professors Taylor and Britten are part-funded by the National Institute for Health Research (NIHR) Collaboration for Peninsula Leadership in Applied Health Research and Care. Professor Jolly is part-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands. Professor Britten is part-funded by the NIHR CLAHRC South West Peninsula. Professor Singh is supported by NIHR CLARCH East Midlands. The funders’ peer-review process informed the trial protocol. The sponsor of the trial had no role in trial design, data collection, data analysis, data interpretation, or writing of the report. The views expressed in this publication are those of the authors and not necessarily of the NIHR or United Kingdom’s Department of Health and Social Care.

PY - 2019/3/18

Y1 - 2019/3/18

N2 - Background: The REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) trial found that the REACH-HF home-based cardiac rehabilitation intervention resulted in a clinically meaningful improvement in disease-specific health-related quality of life in patients with reduced ejection fraction heart failure (HFrEF). The aims of this study were to assess the long-term cost-effectiveness of the addition of REACH-HF intervention or home-based cardiac rehabilitation to usual care compared with usual care alone in patients with HFrEF. Design and methods: A Markov model was developed using a patient lifetime horizon and integrating evidence from the REACH-HF trial, a systematic review/meta-analysis of randomised trials, estimates of mortality and hospital admission and UK costs at 2015/2016 prices. Taking a UK National Health and Personal Social Services perspective we report the incremental cost per quality-adjusted life-year (QALY) gained, assessing uncertainty using probabilistic and deterministic sensitivity analyses. Results: In base case analysis, the REACH-HF intervention was associated with per patient mean QALY gain of 0.23 and an increased mean cost of £400 compared with usual care, resulting in a cost per QALY gained of £1720. Probabilistic sensitivity analysis indicated a 78% probability that REACH-HF is cost effective versus usual care at a threshold of £20,000 per QALY gained. Results were similar for home-based cardiac rehabilitation versus usual care. Sensitivity analyses indicate the findings to be robust to changes in model assumptions and parameters. Conclusions: Our cost-utility analyses indicate that the addition of the REACH-HF intervention and home-based cardiac rehabilitation programmes are likely to be cost-effective treatment options versus usual care alone in patients with HFrEF.

AB - Background: The REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) trial found that the REACH-HF home-based cardiac rehabilitation intervention resulted in a clinically meaningful improvement in disease-specific health-related quality of life in patients with reduced ejection fraction heart failure (HFrEF). The aims of this study were to assess the long-term cost-effectiveness of the addition of REACH-HF intervention or home-based cardiac rehabilitation to usual care compared with usual care alone in patients with HFrEF. Design and methods: A Markov model was developed using a patient lifetime horizon and integrating evidence from the REACH-HF trial, a systematic review/meta-analysis of randomised trials, estimates of mortality and hospital admission and UK costs at 2015/2016 prices. Taking a UK National Health and Personal Social Services perspective we report the incremental cost per quality-adjusted life-year (QALY) gained, assessing uncertainty using probabilistic and deterministic sensitivity analyses. Results: In base case analysis, the REACH-HF intervention was associated with per patient mean QALY gain of 0.23 and an increased mean cost of £400 compared with usual care, resulting in a cost per QALY gained of £1720. Probabilistic sensitivity analysis indicated a 78% probability that REACH-HF is cost effective versus usual care at a threshold of £20,000 per QALY gained. Results were similar for home-based cardiac rehabilitation versus usual care. Sensitivity analyses indicate the findings to be robust to changes in model assumptions and parameters. Conclusions: Our cost-utility analyses indicate that the addition of the REACH-HF intervention and home-based cardiac rehabilitation programmes are likely to be cost-effective treatment options versus usual care alone in patients with HFrEF.

KW - Cardiac rehabilitation

KW - cost-effectiveness

KW - decision model

KW - health-related quality of life

KW - heart failure

KW - home-based

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JO - European Journal of Preventive Cardiology

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