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

Rod S . Taylor (Lead / Corresponding author), Susannah Sadler, Hasnain M. Dalal, Fiona C. Warren, Kate Jolly, Russell C. 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 C. Lang, Karen Smith, REACH-HF investigators

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
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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
Pages (from-to)1252-1261
Number of pages10
JournalEuropean Journal of Preventive Cardiology
Volume26
Issue number12
Early online date18 Mar 2019
DOIs
Publication statusPublished - Aug 2019

Keywords

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

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