Table 1 Summary of economic evaluations, CHEERS score and GRADE quality of evidence
References | Participants, country and time horizon | Type of study and comparators | Inputs | Effectiveness measure | Type of economic evaluation and outcome | CHEERS quality of reporting score (13) | GRADE quality of evidence* (14) |
|---|---|---|---|---|---|---|---|
HF clinic | Â | Â | Â | Â | Â | Â | Â |
Turner [19] | 1163 patients with CHD or HF in 20 primary care practice clinics with follow-up over 12 months Country: United Kingdom | Cluster RCT Patients seen in GP practice (n = 658) versus patients seen weekly in a HF nurse clinic (n = 505) | Costs of intervention, medications, hospital appointments, travel costs and hospitalisation costs | QALYs measured by EuroQol | Cost-effectiveness HF nurse clinics were cost-effective at an ICER of £13 158 per QALY gained UK pounds | 76% | High |
Wijeysundera [20] | 16,443 patients discharged from hospital with HF with follow-up over 12Â years Country: Canada | Cohort study Patients seen in a usual care clinic versus hypothetical cohort managed in a multidisciplinary HF clinic Based on two clinic visits/year | Costs of clinics from existing clinic, staffing costs and overheads, costs of diagnostic tests, medications, hospitalisations, emergency department presentations Transition probabilities from meta-analyses | Life expectancy as measured in the EFFECT study [12] | Cost-effectiveness HF clinics were cost-effective with an ICER of $18,259/life-year gained Canadian dollars | 86% | Moderate |
Craswell [21] | HF patients seen in an outpatient clinic at one hospital with follow-up over 12 months Country: Australia | Pre and post design Patients seen in usual Cardiology clinic (n = 75) versus patients seen fortnightly in a NP titration clinic (n = 139) | Cost of clinic, personnel salary, and consumables from local service for NP clinic Usual Cardiology clinic costs from a national database. Includes same costs as for NP clinic but it is unclear if Cardiologist salary was included | No measure | Cost comparison Total cost per clinic visit was lower in NP titration clinic ($316) versus usual Cardiology clinic ($480) Total cost of NP titration clinic was $136 464 versus total cost of Cardiology clinic $153 456 Australian dollars | 67% | Very low |
Blum [16] | HF patients recently discharged from hospital. Modelling over a lifetime Country: USA | Meta-analysis Standard care versus disease management clinic versus home visits versus case management | Mortality and rehospitalisation modelled from a retrospective cohort of 3 million medicare pateints. Costs of hospitalisations, clinics, staffing, overheads, diagnostic tests, and medications were included. Cost of interventions were from RCTs. Transition probabilities from meta-analyses | QALYs as measured in the EPHESUS trial [23] | Cost-effectiveness with decision analytic decision model Home visits were cost-effective with an ICER of $19,570 per QALY gained All 3 interventions were cost-effective at a WTP of $50,000 US dollars | 96% | High |
HF telemonitoring programs | Â | Â | Â | Â | Â | Â | Â |
Hebert [17] | 406 HF patients from outpatient clinics in Harlem, NY were followed up for 12Â months Country: USA | RCT 203 HF patients assigned to usual care versus 203 HF patients to nurse telephone follow-up including one clinic visit | Costs of intervention, transportation costs, cost of salaries and overheads, cost of hospitalisations, clinics and ED presentations, patient diaries determined time in medical appointments, informal carer costs | QALYs measured by EuroQol-5D | Cost-effectiveness analysis Nurse managed group was cost-effective with an ICER of $17,543 per QALY gained US dollars | 91% | High |
Klersy [22] | HF patients from the community and followed up for 12 months Country: multiple countries | Based on meta-analysis of 21 RCTs of remote monitoring versus usual care | Costs of hospitalisations | QALYs calculated as survival gain multiplied by utility gain Utilities were taken from published trials | Cost-effectiveness Cost differences between the two groups ranged from €300- €1000 favouring RPM with a QALY gain of 0.06 Euros | 91% | High |
Boyne [18] | HF patients from outpatient clinics in 3 hospitals and were followed up for 12 months Country: Netherlands | RCT Total of 382 HF patients were randomised to telemonitoring (n = 197) versus usual care (n = 185) | Cost diary provided data on home care costs, outpatient visits to various healthcare providers and GP visits. Also hospitalisations, ED presentations, and medication costs | QALYs measured by EQ-5D | Cost-effectiveness Telemonitoring was cost-effective with an ICER of €40,321 per QALY gained. However the probability of telemonitoring being cost-effective at a threshold of €50,000 was 48% Euros | 86% | High |
Thokala [15] | HF patients recently discharged from a HF hospitalisation were followed up for six months Time horizon was over 30 years Country: United Kingdom | Network meta-analysis of 21 RCTs (6317 HF patients) comparing usual care with telemonitoring structured telephone support (STS) human-to-human or STS human-to-machine | Costs of the intervention, hospitalisation, and usual care | QALYs were taken from four RCTs of the different interventions | Cost-effectiveness with Markov model Telemonitoring was cost-effective, compared to usual care, at an ICER of £11,873 per QALY gained UK pounds | 86% | High |