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The cost effectiveness of REACH-HF and home-based cardiac rehabilitation in the treatment of heart failure with reduced ejection fraction: a decision model-based analysis

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Author(s)

  • Rod S Taylor
  • Susannah Sadler
  • Hasnain M. Dalai
  • Fiona Warren
  • Kate Jolly
  • Russell C Davis
  • Patrick Joseph Doherty
  • Jackie Miles
  • Colin Greaves
  • Jennifer Wingham
  • Melvyn Hillsdon
  • Charles Abraham
  • Julia Frost
  • Sally Singh
  • Christopher Hayward
  • Victoria Eyre
  • Kevin Paul
  • Chim C Lang
  • Karen Smith

Department/unit(s)

Publication details

JournalEuropean journal of preventive cardiology
DateSubmitted - 27 Nov 2018
DateAccepted/In press - 4 Feb 2019
DatePublished (current) - 18 Mar 2019
Pages (from-to)1-10
Original languageEnglish

Abstract

Background
The REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) trial found that the REACH-HF home-based intervention resulted in a clinically meaningful
improvement in disease-specific health-related quality of life in patients with reduced ejection fraction heart failure (HFrEF). The aim of this study was to assess the longterm cost-effectiveness of the addition of REACH-HF intervention or home-based CR to usual care compared to usual care alone in patients with HFrEF.

Design and methods
A Markov model was developed using a patient lifetime horizon and integrating
evidence from the REACH-HF trial, a systematic review/meta-analysis of randomised trials, estimates of mortality and hospital admission and UK costs at 2015/6 prices.

Taking a UK National Health and Personal Social Services perspective we report the incremental cost per quality-adjusted life-year (QALY) gained, assessing uncertainty using probabilistic and deterministic sensitivity analyses.

Results
In base case analysis, the REACH-HF intervention was associated with per patient
mean QALY gain of 0.30 and an increased mean cost of £126 compared with usual care, resulting in a cost per QALY of £415. Probabilistic sensitivity analysis indicated a 77% probability that REACH-HF is cost effective versus usual care at a threshold of

£20,000 per QALY. Results were similar for home-based CR versus usual care.
Sensitivity analyses indicate the findings to be robust to changes in model assumptions and parameters

Conclusions
Our analyses indicate that the addition of the REACH-HF intervention and home-based CR programmes are likely to be cost-effective treatment options versus usual care alone in patients with HFrEF.

Bibliographical note

© The Author(s) 2018

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