The Cardiac Care Bridge transitional care program for the management of older high-risk cardiac patients: An economic evaluation alongside a randomized controlled trial

Lotte Verweij; Adrianne C. M. Petri; Janet L. MacNeil-Vroomen; Patricia Jepma; Corine H. M. Latour; Ron J. G. Peters; Wilma J. M. Scholte op Reimer; Bianca M. Buurman; Judith E. Bosmans

doi:10.1371/journal.pone.0263130

The Cardiac Care Bridge transitional care program for the management of older high-risk cardiac patients: An economic evaluation alongside a randomized controlled trial

Lotte Verweij, Adrianne C. M. Petri, Janet L. MacNeil-Vroomen, Patricia Jepma, Corine H. M. Latour, Ron J. G. Peters, Wilma J. M. Scholte op Reimer, Bianca M. Buurman, Judith E. Bosmans

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Abstract

Objective
To evaluate the cost-effectiveness of the Cardiac Care Bridge (CCB) nurse-led transitional care program in older (≥70 years) cardiac patients compared to usual care.

Methods
The intervention group (n = 153) received the CCB program consisting of case management, disease management and home-based cardiac rehabilitation in the transition from hospital to home on top of usual care and was compared with the usual care group (n = 153). Outcomes included a composite measure of first all-cause unplanned hospital readmission or mortality, Quality Adjusted Life Years (QALYs) and societal costs within six months follow-up. Missing data were imputed using multiple imputation. Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated by using bootstrapped seemingly unrelated regression.

Results
No significant between group differences in the composite outcome of readmission or mortality nor in societal costs were observed. QALYs were statistically significantly lower in the intervention group, mean difference -0.03 (95% CI: -0.07; -0.02). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.31 at a Willingness To Pay (WTP) of €0,00 and 0.14 at a WTP of €50,000 per composite outcome prevented and 0.32 and 0.21, respectively per QALY gained.

Conclusion
The CCB program was on average more expensive and less effective compared to usual care, indicating that the CCB program is dominated by usual care. Therefore, the CCB program cannot be considered cost-effective compared to usual care.

Original language	English
Article number	e0263130
Number of pages	15
Journal	PLoS ONE
Volume	17
Issue number	1
DOIs	https://doi.org/10.1371/journal.pone.0263130
Publication status	Published - 2022

Funding

This study is funded by a grant from the [1] Netherlands Organization for Health Research and Development (ZonMw) as part of the ‘From Knowledge to Action II program’, grant number 520002002 and is partly financed by the [2] Dutch Research Council (NWO) grant number 023.008.024. The funders had no role in study design, data collection and analysis, and neither in the preparation or publication of the manuscript. [1] https://www.zonmw.nl/nl/over-zonmw/onderwijs/programmas/programma-detail/tussen-weten-en-doen-ii/ [2] https://www.nwo.nl/onderzoeksprogrammas/promotiebeurs-voor-leraren.

Funders	Funder number
ZonMw	520002002
Nederlandse Organisatie voor Wetenschappelijk Onderzoek	023.008.024

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Verweij, L., Petri, A. C. M., MacNeil-Vroomen, J. L., Jepma, P., Latour, C. H. M., Peters, R. J. G., Scholte op Reimer, W. J. M., Buurman, B. M., & Bosmans, J. E. (2022). The Cardiac Care Bridge transitional care program for the management of older high-risk cardiac patients: An economic evaluation alongside a randomized controlled trial. PLoS ONE , 17(1), Article e0263130. https://doi.org/10.1371/journal.pone.0263130

@article{51f8bc8eb09e42d4ba672b9535a25cba,

title = "The Cardiac Care Bridge transitional care program for the management of older high-risk cardiac patients: An economic evaluation alongside a randomized controlled trial",

abstract = "ObjectiveTo evaluate the cost-effectiveness of the Cardiac Care Bridge (CCB) nurse-led transitional care program in older (≥70 years) cardiac patients compared to usual care.MethodsThe intervention group (n = 153) received the CCB program consisting of case management, disease management and home-based cardiac rehabilitation in the transition from hospital to home on top of usual care and was compared with the usual care group (n = 153). Outcomes included a composite measure of first all-cause unplanned hospital readmission or mortality, Quality Adjusted Life Years (QALYs) and societal costs within six months follow-up. Missing data were imputed using multiple imputation. Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated by using bootstrapped seemingly unrelated regression.ResultsNo significant between group differences in the composite outcome of readmission or mortality nor in societal costs were observed. QALYs were statistically significantly lower in the intervention group, mean difference -0.03 (95% CI: -0.07; -0.02). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.31 at a Willingness To Pay (WTP) of €0,00 and 0.14 at a WTP of €50,000 per composite outcome prevented and 0.32 and 0.21, respectively per QALY gained.ConclusionThe CCB program was on average more expensive and less effective compared to usual care, indicating that the CCB program is dominated by usual care. Therefore, the CCB program cannot be considered cost-effective compared to usual care.",

author = "Lotte Verweij and Petri, {Adrianne C. M.} and MacNeil-Vroomen, {Janet L.} and Patricia Jepma and Latour, {Corine H. M.} and Peters, {Ron J. G.} and {Scholte op Reimer}, {Wilma J. M.} and Buurman, {Bianca M.} and Bosmans, {Judith E.}",

note = "With supplementary files. ",

year = "2022",

doi = "10.1371/journal.pone.0263130",

language = "English",

volume = "17",

journal = "PLoS ONE ",

issn = "1932-6203",

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Verweij, L, Petri, ACM, MacNeil-Vroomen, JL, Jepma, P, Latour, CHM, Peters, RJG, Scholte op Reimer, WJM, Buurman, BM & Bosmans, JE 2022, 'The Cardiac Care Bridge transitional care program for the management of older high-risk cardiac patients: An economic evaluation alongside a randomized controlled trial', PLoS ONE , vol. 17, no. 1, e0263130. https://doi.org/10.1371/journal.pone.0263130

The Cardiac Care Bridge transitional care program for the management of older high-risk cardiac patients: An economic evaluation alongside a randomized controlled trial. / Verweij, Lotte; Petri, Adrianne C. M.; MacNeil-Vroomen, Janet L. et al.
In: PLoS ONE , Vol. 17, No. 1, e0263130, 2022.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The Cardiac Care Bridge transitional care program for the management of older high-risk cardiac patients

T2 - An economic evaluation alongside a randomized controlled trial

AU - Verweij, Lotte

AU - Petri, Adrianne C. M.

AU - MacNeil-Vroomen, Janet L.

AU - Jepma, Patricia

AU - Latour, Corine H. M.

AU - Peters, Ron J. G.

AU - Scholte op Reimer, Wilma J. M.

AU - Buurman, Bianca M.

AU - Bosmans, Judith E.

N1 - With supplementary files.

PY - 2022

Y1 - 2022

N2 - ObjectiveTo evaluate the cost-effectiveness of the Cardiac Care Bridge (CCB) nurse-led transitional care program in older (≥70 years) cardiac patients compared to usual care.MethodsThe intervention group (n = 153) received the CCB program consisting of case management, disease management and home-based cardiac rehabilitation in the transition from hospital to home on top of usual care and was compared with the usual care group (n = 153). Outcomes included a composite measure of first all-cause unplanned hospital readmission or mortality, Quality Adjusted Life Years (QALYs) and societal costs within six months follow-up. Missing data were imputed using multiple imputation. Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated by using bootstrapped seemingly unrelated regression.ResultsNo significant between group differences in the composite outcome of readmission or mortality nor in societal costs were observed. QALYs were statistically significantly lower in the intervention group, mean difference -0.03 (95% CI: -0.07; -0.02). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.31 at a Willingness To Pay (WTP) of €0,00 and 0.14 at a WTP of €50,000 per composite outcome prevented and 0.32 and 0.21, respectively per QALY gained.ConclusionThe CCB program was on average more expensive and less effective compared to usual care, indicating that the CCB program is dominated by usual care. Therefore, the CCB program cannot be considered cost-effective compared to usual care.

AB - ObjectiveTo evaluate the cost-effectiveness of the Cardiac Care Bridge (CCB) nurse-led transitional care program in older (≥70 years) cardiac patients compared to usual care.MethodsThe intervention group (n = 153) received the CCB program consisting of case management, disease management and home-based cardiac rehabilitation in the transition from hospital to home on top of usual care and was compared with the usual care group (n = 153). Outcomes included a composite measure of first all-cause unplanned hospital readmission or mortality, Quality Adjusted Life Years (QALYs) and societal costs within six months follow-up. Missing data were imputed using multiple imputation. Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated by using bootstrapped seemingly unrelated regression.ResultsNo significant between group differences in the composite outcome of readmission or mortality nor in societal costs were observed. QALYs were statistically significantly lower in the intervention group, mean difference -0.03 (95% CI: -0.07; -0.02). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.31 at a Willingness To Pay (WTP) of €0,00 and 0.14 at a WTP of €50,000 per composite outcome prevented and 0.32 and 0.21, respectively per QALY gained.ConclusionThe CCB program was on average more expensive and less effective compared to usual care, indicating that the CCB program is dominated by usual care. Therefore, the CCB program cannot be considered cost-effective compared to usual care.

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DO - 10.1371/journal.pone.0263130

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AN - SCOPUS:85123570891

SN - 1932-6203

VL - 17

JO - PLoS ONE

JF - PLoS ONE

IS - 1

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ER -

The Cardiac Care Bridge transitional care program for the management of older high-risk cardiac patients: An economic evaluation alongside a randomized controlled trial

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