Economic Evaluation of an Integrated Health and Social Care Program for Heart Failure Through 2 Different Modeling Techniques

Abstract

Introduction:An integrated health and social care program for patients with heart failure (HF) was implemented at the Friuli-Venezia Giulia deployment site as part of the SmartCare European project. The objective of this study was to validate 2 different decision modeling techniques used to perform the economic evaluation.Methods:Data were collected during the SmartCare project which enrolled 108 patients with HF and followed for more than 6 months. The techniques used were Markov and discrete event simulation models. In both cases, a cost-effectiveness analysis and a budget impact analysis were carried out. The former was used to assign priority to the intervention and the latter to assess its sustainability. Analyses were conducted from the perspective of the Regional Health Authority.Results:Results were similar with both types of model. Cost-effectiveness analysis found no significant differences in quality of life, but the intervention generated significant cost savings, becoming the dominant option. Data extrapolation showed no benefits in terms of mortality or hospital admissions, but budget impact analysis also predicted annual savings, as a significant number of in-hospital days were avoided. In budget analysis, both models predicted early, increasing and cumulative annual savings.Discussion:The integrated program was dominant as it provided better outcomes and lower total costs, and thus, decision-makers should prioritize it. Besides, the work demonstrates the capacity of decision modeling to become a complementary tool in managing integrated health and social care models.

An Integrated Care Platform System (C3-Cloud) for Care Planning, Decision Support, and Empowerment of Patients With Multimorbidity: Protocol for a Technology Trial

“…It was used to inform decision making in the management of integrated care in general and on the expected impact of scaling up the use of C3-Cloud. The aim was to develop a combined tool taking advantage of 2 existing approaches (ASSIST or Assessment and evaluation tools for telemedicine and telehealth [ 16 ] and predictive modeling [ 17 , 18 ]) that have been previously applied in other European projects such as CareWell [ 19 ] and SmartCare [ 20 ]. Merging them aimed to improve reliability and validity of the tool by incorporating the comprehensive perspective applied by ASSIST and the flexible engine developed in predictive modeling to represent mathematically the natural history of the disease.…”

How to Address Uncertainty in Health Economic Discrete-Event Simulation Models: An Illustration for Chronic Obstructive Pulmonary Disease

“…Multiple examples of published studies using patient-level models not reporting extensive details about modeling uncertainty can be found in the literature. 14 – 31 This lack of guidance is not limited to DES models. 32 However, since DES models are less frequently used and are often considered more complex, DES models could benefit more from additional modeling guidance.…”