Göhler A, Geisler BP, Manne JM, Kosiborod M, Zhang Z, Weintraub WS, et al. Utility estimates for decision-analytic modeling in chronic heart failure--health states based on New York Heart Association classes and number of rehospitalizations. Value Health. 2009;12 (1) :185-7. Abstract
OBJECTIVES: For economic evaluations of chronic heart failure (CHF) management strategies, utilities are not currently available for disease proxies commonly used in Markov models. Our objective was to estimate utilities for New York Heart Association (NYHA) classification and number of cardiovascular rehospitalizations. METHODS: EuroQol 5D data from the Eplerenone Post-acute Myocardial Infarction Heart Failure Efficacy and Survival Study trial were used to estimate utilities as a function of NYHA classification and number of cardiovascular rehospitalizations. RESULTS: In multivariate regression analyses adjusted for age (60 years), female sex and absence of further comorbidities, utilities for NYHA classes I-IV were 0.90, 0.83, 0.74, and 0.60 (P-value < 0.001 for trend). For cardiovascular rehospitalizations 0, 1, 2 and >or=3, the associated utilities were 0.88, 0.85, 0.84, and 0.82 (P-value < 0.001 for trend). CONCLUSIONS: NYHA class and number of cardiovascular rehospitalizations are established proxies for CHF progression and can be linked to utilities when used as health states in a Markov model. NYHA class should be used when feasible.
Geisler BP, Levin-Scherz JK. Additional factors that could improve cost-effectiveness of pharmacogenetic-guided dosing in warfarin therapy. Ann Intern Med. 2009;151 (1) :71; author reply 71.
Geisler BP, van Dam RM, Gazelle GS, Goehler A. Risk of bias in meta-analysis on erythropoietin-stimulating agents in heart failure. Heart. 2009;95 (15) :1278-9; author reply 1279.
Göhler A, Conrads-Frank A, Worrell SS, Geisler BP, Halpern EF, Dietz R, et al. Decision-analytic evaluation of the clinical effectiveness and cost-effectiveness of management programmes in chronic heart failure. Eur J Heart Fail. 2008;10 (10) :1026-32. Abstract
BACKGROUND AND AIMS: While management programmes (MPs) for chronic heart failure (CHF) are clinically effective, their cost-effectiveness remains uncertain. Thus, this study sought to determine the cost-effectiveness of MPs. METHODS AND RESULTS: We developed a Markov model to estimate life expectancy, quality-adjusted life expectancy, lifetime costs, and the incremental cost-effectiveness of MPs as compared to standard care. Standard care was defined by the EuroHeart Failure Survey for Germany, MP efficacy was derived from our recent meta-analysis and cost estimates were based on the German healthcare system. For a population with a mean age 67 years (35% female) at onset of CHF, our model predicted an average quality-adjusted life expectancy of 2.64 years for standard care and 2.83 years for MP. MP yielded additional lifetime costs of euro1700 resulting in an incremental cost-utility ratio (ICUR) of euro8900 (95% CI: dominant to 177,100) per quality-adjusted life year (QALY) gained. Sensitivity analyses demonstrated that the ICUR was sensitive to age and sex. CONCLUSION: MPs increase life expectancy in patients with CHF by an average of 84 days and increase lifetime cost of care by approximately euro1700. MPs improve outcomes in a cost-effective manner, although they are not cost-saving on a lifetime horizon.