European Geriatric Medicine
Cost‑eectiveness of a follow‑up program for older patients with heart
failure: a randomized controlled trial
José L. González‑Guerrero
· Miguel A. Hernández‑Mocholi
· José M. Ribera‑Casado
· Nieves García‑Mayolín
· Narcís Gusi
Received: 16 February 2018 / Accepted: 28 May 2018
© European Geriatric Medicine Society 2018
Purpose To assess the cost–utility of adding a disease management program (DMP) delivered by geriatric day hospital
(GDH) for older patients with heart failure (HF) after hospital discharge.
Methods 117 older HF patients discharged by a geriatric service were randomly assigned to DMP (n = 59) and usual care
(UC) (n = 58) groups. The DMP group received health education, therapeutic control and monitoring through both telephone
contacts and face-to-face visits at the GDH for 12 months. The UC group received standard health care. The main outcome
measures were the costs from the health-care system and societal perspectives and quality-adjusted life-years (QALYs) using
EuroQol (EQ-5D-3L). The cost-eﬀectiveness analysis used the package ICEinfer in R 2.13.0.
Results The mean age was 85 years, and 73% of the patients were women. The mean values of QALYs after 12 months
were − 0.083 in DMP and − 0.154 in UC. Each extra QALY gained by the DMP relative to usual care cost was €38,274 and
€25,390 from health-care or societal perspective, respectively. An investment of €44,000/QALY (Spanish Health System
Threshold) showed a 91 and 85% of probability to be cost-eﬀective from health-care and societal perspectives.
Conclusion The intervention was moderately cost-eﬀective in delaying deaths and preserving the loss of health-related qual-
ity of life in older patients with HF. The study was internationally registered with the ISRCTN10823032.
Keywords Heart failure · Elderly patients · Disease management programs · Cost-eﬀectiveness
Heart failure (HF) has become a real challenge for health-
care systems. This is due to its high prevalence, high mor-
tality and costs derived from the disease, especially those
directly caused by the high rate of hospitalization .
There is good evidence in patients with HF and high risk
of hospitalization that multidisciplinary strategies based on
coordination and continuity of care (disease management
programs [DMPs]), subsequent to hospital discharge, can
reduce hospitalizations and mortality rates, improve quality
of life and reduce overall medical costs [2–4].
Given the need to establish priorities for allocating health
resources, tools such as cost-eﬀectiveness analysis have
become increasingly important, in which health outcomes
are measured in terms of survival or quality-adjusted sur-
vival. However, the cost-eﬀectiveness of DMPs compared
to usual clinical care lacks further speciﬁc investigation
due to the complexity of comparing available published
data . There is a scarce number of studies with diﬀerent
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s4199 9-018-0074-y) contains
supplementary material, which is available to authorized users.
* José L. González-Guerrero
* Narcís Gusi
Geriatric Service, Complejo Hospitalario de Cáceres,
Faculty of Sports Sciences, University of Extremadura,
Av. Universidad S/N, 10003 Cáceres, Spain
Geriatric Service, Hospital Clínico San Carlos de Madrid,
Department of Patient Management, Complejo Hospitalario
de Cáceres, Cáceres, Spain