Cost-Consequences of Ultrafiltration for Acute Heart Failure A Decision Model Analysis

被引:38
作者
Bradley, Steven M. [1 ,2 ]
Levy, Wayne C. [2 ]
Veenstra, David L. [3 ]
机构
[1] VA Puget Sound Hlth Care Syst, Hlth Serv Res & Dev, Dept Vet Affairs, Seattle, WA 98101 USA
[2] Univ Washington, Dept Med, Div Cardiol, Seattle, WA USA
[3] Univ Washington, Dept Pharm, Pharmaceut Outcomes Res & Policy Program, Seattle, WA 98195 USA
来源
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES | 2009年 / 2卷 / 06期
关键词
heart failure; ultrafiltration; diuretics; costs and cost analysis; HEPARIN-INDUCED THROMBOCYTOPENIA; MOLECULAR-WEIGHT HEPARIN; CONTINUOUS VENOVENOUS HEMOFILTRATION; DISEASE MANAGEMENT PROGRAMS; UNFRACTIONATED HEPARIN; HOSPITALIZED-PATIENTS; READMISSION RATES; OLDER PATIENTS; ANTICOAGULATION; CARE;
D O I
10.1161/CIRCOUTCOMES.109.853556
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Ultrafiltration for heart failure may reduce costs associated with acute heart failure by decreasing rehospitalization rates compared to intravenous diuretics. Methods and Results-We developed a decision-analytic model to explore the clinical outcomes and associated costs of ultrafiltration compared to intravenous diuretics for index and subsequent acute heart failure hospitalizations to 90 days from index hospitalization. We evaluated the model from societal, Medicare, and hospital payer perspectives. Base-case probabilities and costs were derived from the Ultrafiltration versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Congestive Heart Failure clinical trial, Medicare reimbursement schedules, and published data. From a societal perspective, treatment with ultrafiltration had an 86% probability of being more expensive than intravenous diuretics in probabilistic sensitivity analysis, with a base-case estimate of $13 469 per patient treated with ultrafiltration compared to $11 610 per patient treated with intravenous diuretics. Cost estimates were most influenced by length of index hospitalization, daily cost of rehospitalization, number of days rehospitalized, and number and cost of ultrafiltration filters. From a Medicare payer perspective, ultrafiltration had a >99% probability of being cost saving. From a hospital perspective, there was a 97% probability ultrafiltration was more expensive. Our model suggested similar 90-day mortality rates between treatment arms. Conclusion-Despite a reduction in rehospitalization rates, it is unlikely ultrafiltration results in cost savings from a societal perspective. The discordance in cost between societal, Medicare, and hospital perspectives underscores the importance of payer perspective in formulating strategies and reimbursement structures to reduce heart failure hospitalizations. (Circ Cardiovasc Qual Outcomes. 2009; 2: 566-573.)
引用
收藏
页码:566 / U99
页数:13
相关论文
共 48 条
[1]  
[Anonymous], 1996, Cost-effectiveness in health and medicine
[2]  
[Anonymous], 2007, RED BOOK
[3]   An Improved Set of Standards for Finding Cost for Cost-Effectiveness Analysis [J].
Barnett, Paul G. .
MEDICAL CARE, 2009, 47 (07) :S82-S88
[4]   Ultrafiltration versus usual care for hospitalized patients with heart failure - The relief for acutely fluid-overloaded patients with decompensated congestive heart failure (RAPID-CHF) trial [J].
Bart, BA ;
Boyle, A ;
Bank, AJ ;
Anand, I ;
Olivari, MT ;
Kraemer, M ;
Mackedanz, S ;
Sobotka, PA ;
Schollmeyer, M ;
Goldsmith, SR .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2005, 46 (11) :2043-2046
[5]   Sustained low-efficiency dialysis in the ICU: Cost, anticoagulation, and solute removal [J].
Berbece, A. N. ;
Richardson, R. M. A. .
KIDNEY INTERNATIONAL, 2006, 70 (05) :963-968
[6]  
Betjes MGH, 2007, J NEPHROL, V20, P602
[7]   Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections [J].
Blot, SI ;
Depuydt, P ;
Annemans, L ;
Benoit, D ;
Hoste, E ;
de Waele, JJ ;
Decruyenaere, J ;
Vogelaers, D ;
Colardyn, F ;
Vandewoude, KH .
CLINICAL INFECTIOUS DISEASES, 2005, 41 (11) :1591-1598
[8]   Comparing willingness to pay for telemedicine across a chronic heart failure and hypertension population [J].
Bradford, WD ;
Kleit, A ;
Krousel-Wood, MA ;
Re, RM .
TELEMEDICINE JOURNAL AND E-HEALTH, 2005, 11 (04) :430-438
[9]   When heparin causes thrombosis: Significance, recognition, and management of heparin-induced thrombocytopenia in dialysis patients [J].
Chang, John Jae Young ;
Parikh, Chirag R. .
SEMINARS IN DIALYSIS, 2006, 19 (04) :297-304
[10]   Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure [J].
Costanzo, Maria Rosa ;
Guglin, Maya E. ;
Saltzberg, Mitchell T. ;
Jessup, Mariell L. ;
Bart, Bradley A. ;
Teerlink, John R. ;
Jaski, Brian E. ;
Fang, James C. ;
Feller, Erika D. ;
Haas, Garrie J. ;
Anderson, Allen S. ;
Schollmeyer, Michael P. ;
Sobotka, Paul A. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 49 (06) :675-683