Date of Award

January 2016

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Shiyi Wang

Abstract

Background: Multidisciplinary management program (MMP) or exercise training program (ETP) is cost-effective in treating heart failure patients compared with usual care (UC), but no comparison across these three strategies has been made.

Objective: To estimate and compare the cost-effectiveness of MMP, ETP, or UC.

Design: Cohort simulations using a Markov model.

Data Sources: Derived from literature.

Participants: Heart failure (HF) patients aged 56-80 years old.

Time horizon: 10 years.

Intervention: UC, MMP (including disease education and continuous social and psychological support) and ETP (including exercise training and the basic support in MMP).

Outcome Measures: Life-year saved, lifetime costs, and incremental cost-effectiveness ratio (ICER) as measured by cost per life-year saved.

Results of Base-Case Analysis: UC yielded 6.75 life-years saved, MMP 7.12 life-years saved, and ETP 7.93 life-years saved. The associated costs were $10,694, $12,007, and $37,635, respectively. The ICERs were $3,535 per life-year saved in MMP vs. UC, and $31,624 per life-year saved in ETP vs. MMP.

Results of Sensitivity Analysis: The ICERs ranged from $1,307 to $4,743 per life-year saved in MMP vs. UC, and from $16,043 to $42,397 per life-year saved in ETP vs. MMP.

Limitation: No trials have directly compared MMP with ETP; different sources of input data.

Conclusion: In patients with heart failure, MMP and ETP appear to be cost-effective.

Comments

This is an Open Access Thesis.

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