Cost-Effectiveness of a Home Visit Program for Patients with Heart Failure in Brazil: Evidence from a Randomized Clinical Trial

Abstract

Objective: Estimate the cost-effectiveness of a nurse-led home visit (HV) intervention as compared with the standard HF management, within a randomized clinical trial in Brazil. Study Design: Costeffectiveness study within a randomized trial. Methods: To assess the cost-effectiveness of four home visits and four telephone calls by nurses in the management of patients with HF within a randomized clinical trial (RCT: NCT01213875) in a perspective Public (PHS-Public Healthcare System) and private healthcare systems of Brazil during time frame of 24 weeks. The outcome was a composite endpoint hospital readmission rate (first visit to the emergency room (ER) and hospital readmission), or all-cause death and incremental cost-effectiveness ratio (ICER) of the study intervention to conventional management. Results: Home-based intervention was associated with a reduction in composite endpoint (RR 0.73; 95% confidence interval 0.54 -0.99; P ¼ 0.049), but at greater cost from the PHS perspective. The ICER at 24 weeks was R$585 per hospital readmission visit prevented. Within the private health insurance framework, home visits were associated with lower costs and lower readmission rates. Results were sensitive to the relative risk of the study intervention, admissions and intervention costs. Conclusions: In Brazil, an intervention based on nurse-led home visits of patients with HF showed a favorable cost-effectiveness profile within the framework of the PHS and was dominant within the private healthcare system. Our analysis suggests that implementation of this program could not only benefit patients, but also provide a financial incentive to health administrators.

Effect of Educational Interventions to Reduce Readmissions due to Heart Failure Decompensation in Adults: a Systematic Review and Meta-analysis

“… 9 months Standard care Intervention: 30 Rodríguez-Gázquez et al, 2012 ( 45 ) Colombia 63 Educational program in nursing (educational meetings, home visits, telenursing and a printed book) in the improvement of self-care behaviors. 9 months Standard care Control: 24 Ruschel et al ., 2018 ( 46 ) Brazil 252 Home visits and phone calls. Education on HF and self-care practices.…”

“…Education on HF and self-care practices. 6 months Standard care Readmissions* at 6 months Ruschel et al ., 2018 ( 46 ) Brazil 252 Home visits and phone calls. Education on HF and self-care practices.…”

Narrative synthesis of the effectiveness and characteristics of heart failure disease self‐management support programmes

“…We identified some evidence that effective DSMS programmes could be implemented in upper middle-income countries such as China and Brazil, with the majority of effective programmes implementing moderate-intensity interventions. [28][29][30][31][32] Across the eight systematic reviews, low-intensity programmes that focus on patient education and discharge planning accounted for 7-40% of effective programmes, indicating some albeit inconsistent benefits for these programmes. Moderate-intensity interventions, that include longer follow-up support in the community, emphasizing self-management training to recognize signs of clinical deterioration and provided mechanisms for rapid review by an expert clinician when changes in symptoms occurred accounted for 20-72% of effective programmes.…”

“…Seven (5.1%) studies were conducted in upper middle-income countries; five studies conducted in China and Brazil respectively were found to be effective. [28][29][30][31][32] There were 6 (4.4%) unique studies conducted in LMICs (Iran, n = 3; Columbia, n = 2; and India, n = 1); none of these studies demonstrated effectiveness (Supporting Information, Table S3). There were no studies included in the included systematic reviews evaluating HF DSMS programmes in low-income countries (Table 5).…”

Elements Characterising Multicomponent Interventions Used to Improve Disease Management Models and Clinical Pathways in Acute and Chronic Heart Failure: A Scoping Review

“…The majority of studies included HF patients with HFrEF (LVEF < 40%) (n = 19), while only four [41,49,50,122] and one study [154] considered patients with HFmrEF (LVEF 40-49%) and HFpEF (LVEF ≥ 50%), respectively. Twenty-two studies examined specific target populations with LVEF range that overlap with the ESC classification, such as LVEF ≤ 55% (3 studies) [107,177,178], LVEF ≥ 45% (4 studies) [86,128,141,146], and LVEF ≤ 45% (21 studies) [36,41,44,49,50,73,80,91,93,115,122,126,136,141,143,145,146,155,163,177,180].…”