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The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: A decision model-based analysis

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posted on 20.05.2020, 10:50 by Rod S Taylor, Susannah Sadler, Hasnain M Dalal, Fiona C Warren, Kate Jolly, Russell C Davis, Patrick 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, Carolyn Deighan, Louise Taylor, Jenny Elliott, Martin Cowie, Graham Dunn, Suzanna Hardman, Roger Boyle, Liz Clark, Ann Dorthe-Zwisler, Alan Montgomery, Gill Furze, Iain Squire, Sern Lim, Paco Leyva
Background: The REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) trial found that the REACH-HF home-based cardiac rehabilitation 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 aims of this study were to assess the long-term cost-effectiveness of the addition of REACH-HF intervention or home-based cardiac rehabilitation to usual care compared with 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 2015/2016 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 0.23 and an increased mean cost of £400 compared with usual care, resulting in a cost per QALY gained of £1720. Probabilistic sensitivity analysis indicated a 78% probability that REACH-HF is cost effective versus usual care at a threshold of £20,000 per QALY gained. Results were similar for home-based cardiac rehabilitation versus usual care. Sensitivity analyses indicate the findings to be robust to changes in model assumptions and parameters. Conclusions: Our cost-utility analyses indicate that the addition of the REACH-HF intervention and home-based cardiac rehabilitation programmes are likely to be cost-effective treatment options versus usual care alone in patients with HFrEF.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this work was supported by the United Kingdom’s National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number RP-PG-1210-12004). RST and Britten are part-funded by the National Institute for Health Research (NIHR) Collaboration for Peninsula Leadership in Applied Health Research and Care. KJ is part-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands. SSi is supported by NIHR CLARCH East Midlands. The funders’ peer-review process informed the trial protocol. The sponsor of the trial had no role in trial design, data collection, data analysis, data interpretation, or writing of the report. The views expressed in this publication are those of the authors and not necessarily of the NIHR or United Kingdom’s Department of Health and Social Care.

History

Citation

Taylor, R. S., Sadler, S., Dalal, H. M., Warren, F. C., Jolly, K., Davis, R. C., … Smith, K. (2019). The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: A decision model-based analysis. European Journal of Preventive Cardiology, 26(12), 1252–1261. https://doi.org/10.1177/2047487319833507

Version

VoR (Version of Record)

Published in

EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY

Volume

26

Issue

12

Pagination

1252 - 1261 (10)

Publisher

SAGE PUBLICATIONS LTD

issn

2047-4873

eissn

2047-4881

Acceptance date

04/02/2019

Copyright date

2019

Available date

18/03/2019

Language

English