Novel Heart Failure Rehab Intervention May Hold Economic Value in the Longer Term

Because its long-term value remains uncertain, the cost-effectiveness of a novel 12-week intervention for patients with acute heart failure (HF)—especially those with HF with preserved ejection fraction (HFpEF)—that was investigated in the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial needs additional study, reports JAMA Cardiology.

This intervention began during hospitalization and comprised 36 sessions that took place over 12 weeks, for a 1:1 session 3 days per week. The patients randomized to this intervention supplemented it with home exercise that included walking and strengthening exercises and discussed their adherence through monthly phone calls.

“The intervention may yield good value to the health care system,” the authors wrote. “However, long-term cost-effectiveness is currently uncertain and dependent on the assumption that benefits are sustained beyond study follow-up.”

For this purpose, they investigated results among 349 patients hospitalized for acute decompensated HF (53.0%, HFpEF; 47.0%, HF with reduced ejection fraction) and enrolled in the study between September 17, 2014, and September 19, 2019. The 5-level EuroQol 5-Dimension (EQ-5D-5L) scales were used to collect medical resource use and quality of life (QOL) information; 2019 US Medicare payments and the Federal Supply Schedule were utilized to estimate medical resource use and medication costs, respectively; and the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model estimated cost-effectiveness.

Their aim with this secondary analysis of REHAB-HF was to produce economic outcomes data on costs, quality-adjusted life-years, and the incremental cost-effectiveness ratio (ICER) for 349 patients (52.4%, women; 50.4%, non-White; 49.6, White; mean [SD] age, 72.7 [8.1] years) randomized to the intervention or the control group.

Excluding intervention costs, patients in the intervention group had mean (SD) cumulative costs of $26,421 ($38,955) compared with $27,650 ($30,712) in the control group (95% CI, –$8159 to $6394); the mean (SD) cost of the intervention itself was $4204 ($2059). Including intervention costs, the per-patient mean (SD) cost for the intervention group rose to $30,625 ($38,442). This group also had higher mean (SD) indirect costs, at $2323 ($1995) vs $1093 ($1629) for the control group; these costs included completed intervention sessions, patient-reported nonstudy rehab sessions, and time for travel and home exercise.

In addition, over a 6-month follow-up, the intervention group saw significantly greater sustained QOL gains vs the control group (mean utility difference, 0.074; P = .001). Per QALY gained, the overall ICER was $58,409 for the entire patient group and $35,600 for those with HFpEF.

Medical resource use did not differ significantly between the intervention and control groups, which had mean (SD) all-cause per-patient hospitalizations of 1.10 (1.37) and 1.22 (1.44) (P = .63), respectively. However, those in the intervention group did have far fewer non–study related rehab visits vs the control group: 2.99 (6.50) vs 6.71 (11.54). Overall, the intervention group had consistently higher mean EQ-5D-5L scores at all follow-up visits.

Because the effects of behavioral interventions are known to wane over time, the authors noted, their results should be interpreted with caution. However, their results are still noteworthy because they suggest “longer-term effects of this novel rehabilitation intervention on QALYs attributable to improvements in physical functioning may yield good economic value to the US health care system.”

Still they recommend a larger-scale trial that incorporates extended surveillance and secondary data on the long-term value of the REHAB-HF intervention program.

Reference

Chew DS, Li Y, Zeitouni M, et al. Economic outcomes of rehabilitation therapy in older patients with acute heart failure in the REHAB-HF trial: a secondary analysis of a randomized clinical trial. JAMA Cardiol. Published online November 24, 2021. doi:10.1001/jamacardio.2021.4836