HerzMobil an Effective Disease Management Program for Chronic Heart Failure – Evidence on Cost Effectiveness in Tyrol and Other Regions

Objective Heart failure (HF) is recognized as an escalating public health problem. In Tyrol, a 3-month transitional, telemedicine assisted, post-discharge disease management program (DMP, HerzMobil) for HF patients has been implemented. The implementation of DMP-HF in other federal states in Austria is ongoing and requires evidence to support implementation decisions. Our updated analysis aimed to assess the cost effectiveness of the DMP-HF in Tyrol and to provide decision support for continued implementation across Austria.

Methods We conducted a cost-effectiveness analysis along a retrospective cohort study (2016-2019) of the routine DMP-HF in Tyrol, Austria with a propensity-score matched cohort of 257 individuals in the usual care (UC) and 251 in the DMP group and a one-year follow up. We determined the effectiveness (hospital-free life expectancy, life-years gained, and number of avoided rehospitalizations), costs (DMP, rehospitalizations) and the incremental cost-effectiveness ratio (ICER) of DMP-HF vs. UC. Data preparation included missing value imputation and adjustment for remaining confounding due to imperfect matching. We performed bootstrap sampling and a sensitivity analysis on HF-rehospitalizations costs considering costs per disease-related diagnosis (DRG) in eight further federal states. Upcoming evidence of program implementations in other federal states will be compared to Tyrolean analyses.

Results On average, DMP-HF results in 42 additional hospital-free days, 40 additional life days, and 0.12 avoided hospitalizations per person compared to UC. The average DMP costs are EUR 1,916 per person. Mean rehospitalization costs are EUR 5,551 in DMP-HF and EUR 6,943 in UC. The ICER of DMP-HF compared to UC is 4,773 EUR/life-year gained outside the hospital (LYGoH) in Tyrol. The ICER varied considerably with federal state-specific DRG-scores, leading to an ICER of 2,567 EUR/LYGoH or 1,546 EUR/LYGoH in Burgenland and Styria, respectively. DMP-HF was cost saving when "high irrelevant costs" related to the DMP were replaced with average costs.

Conclusions Our study showed that the DMP-HF is cost effective compared to UC based on Tyrolian data and using further region-specific DRG-scores. Implementation of telemedicine-assisted DMP-HF throughout Austria will further be supported by future long-term decision analysis using Tyrolian data and real-world evidence generation in further federal states.