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

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 - Taylor, Rod S .

AU - Sadler, Susannah

AU - Dalal, Hasnain M.

AU - Warren, Fiona C.

AU - Jolly, Kate

AU - Davis, Russell C.

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 C.

AU - Smith, Karen

AU - REACH-HF investigators

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 - 2019/8

Y1 - 2019/8

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

UR - https://www.scopus.com/pages/publications/85063316940

U2 - 10.1177/2047487319833507

DO - 10.1177/2047487319833507

M3 - Article

C2 - 30884975

SN - 2047-4873

VL - 26

SP - 1252

EP - 1261

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 12

ER -