ABSTRACT
PURPOSE: To assess the cost-utility of adding a disease management program (DMP) delivered by geriatric day hospital (GDH) for older patients with heart failure (HF) after hospital discharge. METHODS: 117 older HF patients discharged by a geriatric service were randomly assigned to DMP (n = 59) and usual care (UC) (n = 58) groups. The DMP group received health education, therapeutic control and monitoring through both telephone contacts and face-to-face visits at the GDH for 12 months. The UC group received standard health care. The main outcome measures were the costs from the health-care system and societal perspectives and quality-adjusted life-years (QALYs) using EuroQol (EQ-5D-3L). The cost-effectiveness analysis used the package ICEinfer in R 2.13.0. RESULTS: The mean age was 85 years, and 73% of the patients were women. The mean values of QALYs after 12 months were - 0.083 in DMP and - 0.154 in UC. Each extra QALY gained by the DMP relative to usual care cost was 38,274 and 25,390 from health-care or societal perspective, respectively. An investment of 44,000/QALY (Spanish Health System Threshold) showed a 91 and 85% of probability to be cost-effective from health-care and societal perspectives. CONCLUSION: The intervention was moderately cost-effective in delaying deaths and preserving the loss of health-related quality of life in older patients with HF. The study was internationally registered with the ISRCTN10823032.
ABSTRACT
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Subject(s)
Humans , Aged , Cardiac Surgical Procedures , Cardiovascular Diseases/surgery , Health Services for the Aged/organization & administration , Aging , Geriatric AssessmentABSTRACT
The continued aging of the population is an acknowledged fact. The proportion of individuals in the European Union aged over 65 years will reach 29.9% by 2050, almost double the present figure of 16.4%. Approximately one third of people in this age-group has clinically significant cardiovascular disease. Physicians dealing with cardiology in older patients have to be aware of the specific clinical and prognostic features of cardiovascular disease in the elderly, and with its treatment. Consequently, it is clear that continuing medical education in geriatric cardiology is essential, and that is one of the tasks of the Working Group on Geriatric Cardiology. This special issue provides a magnificent opportunity for presenting an update on important topics in geriatric cardiology, such as the aging of the cardiovascular system, heart failure, and atrial fibrillation.
Subject(s)
Atrial Fibrillation , Heart Failure , Age Factors , Atrial Fibrillation/drug therapy , Heart Failure/drug therapy , Heart Failure/epidemiology , Heart Failure/therapy , Humans , PrognosisABSTRACT
El continuo envejecimiento de la población es una auténtica realidad. La media de personas de más de 65 años en la Unión Europea alcanzará el 29,9% en 2050, casi el doble del 16,4% que hay en la actualidad. Aproximadamente, un tercio de personas en esta edad tiene enfermedad cardiovascular clínica. Los médicos responsables del paciente cardiópata anciano deben estar familiarizados con las diferentes manifestaciones clínicas, pronósticas y de manejo de las enfermedades cardiovasculares en la senectud. Así, la necesidad de continuar la educación médica en cardiología geriátrica es evidente en sí, y ése es uno de los cometidos de la sección de cardiología geriátrica. Este número extraordinario de la revista es una magnifica oportunidad para actualizar aspectos importantes de la cardiología geriátrica, como el envejecimiento cardiovascular, la insuficiencia cardíaca y la fibrilación auricular (AU)
The continued aging of the population is an acknowledged fact. The proportion of individuals in the European Union aged over 65 years will reach 29.9% by 2050, almost double the present figure of 16.4%. Approximately one third of people in this age-group has clinically significant cardiovascular disease. Physicians dealing with cardiology in older patients have to be aware of the specific clinical and prognostic features of cardiovascular disease in the elderly, and with its treatment. Consequently, it is clear that continuing medical education in geriatric (..) (AU)
