Result card

  • ECO3: What were the measured and/or estimated costs of Structured telephone support (STS) for adult patients with chronic heart failure and its comparator, 'usual care' without STS (resource-use valuation)?
English

What were the measured and/or estimated costs of Structured telephone support (STS) for adult patients with chronic heart failure and its comparator, 'usual care' without STS (resource-use valuation)?

Authors: Neill Booth, Taru Haula and Heidi Stuerzlinger (supported by Ingrid Rosian-Schikuta).

Internal reviewers: Matthias Schwenkglenks, Nadine Berndt and Fabio Trimaglio

Acknowledgments: We would like to thank information specialist Jaana Isojärvi (THL, Finland) for development of systematic literature search strategies for the ECO domain, and for performing those searches in the available databases. We would also like to acknowledge her generous contribution in helping to construct a Refworks database and in sourcing numerous published articles for review.

For this section we used results from the domain search (including domain searches from EFF and ORG; search strategy and selection criteria are described in the general methodology description) as well as results from an additional hand search, e.g. within study references. Also results from the TEC domain regarding description of the interventions were used.

The following table lists the resource items included in the three studies {1, 3, 4} that were selected as exemplifying STS cost items, together with measured and/or estimated costs as given in those studies. Concerning costs, in the modelling study of Miller et al. (2009) it should be noted that only patients with systolic heart failure were included. Miller et al. also use the assumption that both the intervention and the subsequent effects of the intervention last for the modelled patients’ lifetimes. In contrast, Pandor et al. (2013) {4} assume 1) the intervention lasts for six months, and 2) there are benefits due to reduced hospitalisations (producing HRQoL benefits) as well as 3) reduced mortality in the first 6 months. A lifetime perspective on health effects and costs is modelled by there being more people alive in the intervention group, after the first six months, than in the ‘usual care’ group, and this results in relatively more life years, and associated costs, in the STS groups.

Table 4: Resource consumption for STS, usual care, long term care and hospitalization: measured and/or estimated costs

Structured telephone support (human to human)

 

 

Resources

Unit

Costs per 6 months of treatment*

  

KLERSY ET AL. 2011 {1} (2009 Euros)

MILLER ET AL. 2009 {3} (2003 U.S. Dollars)

PANDOR ET AL.*** 2013 {4} (2013 Euros)

AT THE PATIENT'S HOME

 

 

 

 

Telephone

device

Not included

107.00

= average program cost per patient per month

16.00

Scale

device

Not included

23.00

Blood pressure device

device

Not included

IN THE SUPPORT CENTRE

 

 

 

 

Employed nurse (telephone calls, triage, decision making)

hour

Not included

See above

640.00

Data management software

site licence

Not included

3.00

OTHER HEALTH CARE RESOURCES

 

 

 

 

Family practitioner

office visits

Not included

241.66 - 280.66**

= resource expenditures for “office visits”

155.00

 

home visits

Not included

108.00

Specialist

office visits

Not included

30.00

 

home visits

Not included

2.00

Nurse and other

office visits

Not included

15.00

 

home visits

Not included

44.00

Pharmaceuticals

unclear

Not included

Noncardiovascular: 1539.89-1978.61**

Not included

  

 

Cardiovascular:

794.24-871.60

 

Emergency room

emergency room visits

Not included

HF: 18.49-66.78**

39.00

  

 

Non HF: 47.23-96.69**

 

Other outpatient services

outpatient procedures

Not included

555.00-765.33**

Not included

Laboratory tests

unclear

Not included

49.18-65.40**

Not included

Usual care

 

 

Resources

Unit

Costs per 6 months of treatment

OTHER HEALTH CARE RESOURCES

 

 

 

 

Family practitioner

office visits

Not included

204.40 - 296.64**

= resource expenditures for “office visits”

61.00

 

home visits

Not included

49.00

Specialist

office visits

Not included

18.00

 

home visits

Not included

    Nurse and other

    office visits

    Not included

    10.00

     

    home visits

    Not included

    11.00

    Pharmaceuticals

    e.g. DDD

    Not included

    Noncardiovascular: 1441.81-1936.88**

    Not included

      

     

    Cardiovascular:

    814.38-876.04

     

    Emergency room

    emergency room visits

    Not included

    HF: 13.74-48.80**

    12.00

      

     

    Non HF: 43.65-83.82**

     

    Other outpatient services

    outpatient procedures

    Not included

    560.08-893.54**

    Not included

    Laboratory tests

    unclear

    Not included

    45.53-61.82**

    Not included

    Post treatment  / long term costs

     

     

    Resources

    Unit

    Costs per 6 months of treatment

    OTHER HEALTH CARE RESOURCES

     

     

     

     

    Family practitioner / Specialist

    office visits

    Not included

    Costs assumed to be the same as for the first 6 months, see above

    46.00

    Laboratory tests

    test

    Not included

    3.00

    Hospitalizations

     

     

    Resources

    Unit

    Costs per inpatient admission

      

    All

    STS:

    Usual care:

    All

    HF related hospitalization

    inpatient admissions

    3473.00

    299.66-1062.10**

    176.15-1098.09**

    2514.00

    Other-cause hospitalization

    inpatient admissions

    Not included

    740.16-1876.72**

    677.59-1422.11**

    1530.00

    Inpatient procedures

    Inpatient procedure fees

      260.72-536.48**

      198.45-497.23**

                

        * If not indicated otherwise.

        ** Range, depending on New York Heart Association (NYHA) Functional Classification –status. *** Only the average values of Table 3 are reported here.

        The above table gives an idea about the rough dimensions of costs. Cost values however cannot directly be compared – not only because of different currencies and cost years, but also because of differing interventions, different modelling assumptions, and different populations between the studies.

        All the studies reviewed here use charges or fees for estimating costs of the health care sector. Although these prices may not reflect the true opportunity costs of resource use, they seem to be justified for pragmatic reasons. Perhaps because of the assumptions in their model, Pandor et al. (2013) conclude that intervention costs only constitute a small part of the overall costs, hospitalization costs being the main contributor to those overall costs {4}. However, in all studies the question of the duration of treatment effects (whether of six to 18 months or lifetime -duration) and the implied costs is important.

        The results from ORG8 provide the information that more than 70% of the studies reviewed by Grustam et al. (2014) did not take into account some cost items, or any costs, in at least one of the following categories:  healthcare sector; other sectors; costs to patients or family; and productivity losses for the patient or family {15}. None of the studies broadly analysed the shift of cost, for instance, from specialist HF nurses to general practitioners. In 80% of those studies the perspective, the source and the methods of the evaluations were not clear {15}. Authors mostly focused on direct costs and did not include indirect costs (e.g., productivity gains or losses) or ‘intangible costs’ (such as relief from pain, lost leisure time for patients or families). Of course, depending on the chosen analytical perspective, such approaches can be justified, however, some costs were not clearly included across majority of the studies, such as those costs related to the intervention’s overheads, costs associated with the training of personnel, and patient-related costs. It is also possible to value participant time,  in terms of labour, using either wages or a value for unpaid work. The valuation of participant time can be considered to be particularly relevant if the intervention has a long duration. Despite such considerations, the quality of evidence in much of the available scientific literature is poor, therefore, more studies on all aspects of costs related to STS would be needed to reach an unbiased conclusion {15}.

        Critical
        Not
        Booth N, . T Result Card ECO3 In: Booth N, . T Costs and economic evaluation In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 16 June 2021]. Available from: http://corehta.info/ViewCover.aspx?id=305

        References