Result card

  • ECO4: What is (are) the measured and/or estimated health-related outcome(s) of Structured telephone support (STS) for adult patients with chronic heart failure and its comparator, 'usual care' without STS?
English

What is (are) the measured and/or estimated health-related outcome(s) of Structured telephone support (STS) for adult patients with chronic heart failure and its comparator, 'usual care' without STS?

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.

In ECO4 we report findings from the literature and from other domains, such as SAF and EFF on the effectiveness of ‘STS’ versus ‘usual care’ as they relate to health-related outcomes which can be considered important in the ECO domain. Given the weaknesses of the available evidence, we do not report extensive numerical results from the included studies but, instead, briefly describe some of the findings from those studies. This description includes information from the included economic evaluation studies in general, and Pandor et al (2013) {4} and Thokala et al (2013) {5} in particular.

In the most recent cost-effectiveness analysis (Pandor et al (2013) {4}; Thokala et al (2013) {5}) the main outcomes of interest all-cause mortality and hospitalisations. In these studies a Markov model was developed to estimate the prognosis for each HF patient using the monthly probability of death and monthly risks for hospitalisation from HF-related and other causes. Effectiveness parameters during the treatment period were the hazard ratios (HR) for all-cause mortality, all-cause hospitalisations and HF-related hospitalisations. Cost parameters, either estimated or based on clinical opinion, included both the costs of the intervention and costs related to hospitalisation.

The study of Miller et al (2009) estimated the long-term impact of telephonic disease management (TDM) in systolic heart failure patients from the results of an 18-month South Texas trial with a Markov model (Galbreath et al. 2004 {8}). Effectiveness was expressed as discounted QALYs saved with the DM compared to control group without TDM. The utility-adjustment weights were developed by NYHA class from the baseline results of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) collected from all trial participants, and the estimated mean utility-adjustment weights were 0.75 for NYHA I, 0.64 for NYHA II and 0.58 for NYHA III and IV.

It was noted in the work by Pandor et al (2013) {4} and Thokala et al (2013) {5} presenting results from the same cost-effectiveness modelling study that clear descriptions of the interventions and usual care were not provided in many of the studies and that this had implications for the robustness of analyses of effectiveness. In addition, results from the EFF domain show that at least half the studies included in Feltner et al. 2014 {12} are classified as having a high risk of bias. Although "all-cause death" appears to be reduced in some studies (in a statistically significant manner), a similar reduction is not reported for "disease-specific" or "disease-related" death. This could be due to small sample sizes in the trials, but although Krum et al. (2013) {13} report all-cause hospitalisation to occur more frequently in the control group, their clinical indicator, the Packer clinical composite score, does not show a statistically significant difference between the arms. Moreover, it is not clear to what extent the combination of the endpoints of “all-cause death” and “HF hospitalisation” which are used in a number of studies can be seen as valid, composite, health-related outcomes. Further, the intermediate health-related outcome “HF hospitalisation rate” alone does not tell us to what extent there could be “over-treatment” in a ‘Usual Care’ -group or “under-treatment” in a ‘STS’ –group, nor does it necessarily provide information related to any associated changes in costs.

Important
Partially
Booth N, . T Result Card ECO4 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