Systematic review of trial-based analyses reporting the economic impact of heart failure management programs compared with usual care

Shoko Maru, Joshua Byrnes, Melinda J. Carrington, Simon Stewart, Paul A. Scuffham

Research output: Contribution to journalReview ArticleResearchpeer-review

10 Citations (Scopus)


Background: The cost-effectiveness of heart failure management programs (HF-MPs) is highly variable. We explored intervention and clinical characteristics likely to influence cost outcomes. Methods: A systematic review of economic analyses alongside randomized clinical trials comparing HF-MPs and usual care. Electronic databases were searched for English peer-reviewed articles published between 1990 and 2013. Results: Of 511 articles identified, 34 comprising 35 analyses met the inclusion criteria. Eighteen analyses (51%) reported a HF-MP as more effective and less costly; four analyses (11%), and five analyses (14%) also reported they were more effective but with no significant or an increased cost difference, respectively. Alternatively, five analyses (14%) reported no statistically significant difference in effects or costs, and one analysis (3%) reported no statistically significant effect difference but was less costly. Finally, two analyses (6%) reported no statistically significant effect difference but were more costly. Interventions that reduced hospital admissions tended to result in favorable cost outcomes, moderated by increased resource use, intervention cost and/or the durability of the intervention effect. The reporting quality of economic evaluation assessed by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist varied substantially between 5% and 91% (median 45%; 34 articles) of the checklist criteria adequately addressed. Overall, none of the study, patient or intervention characteristics appeared to independently influence the cost-effectiveness of a HF-MP. Conclusion: The extent that HF-MPs reduce hospital readmissions appears to be associated with favorable cost outcomes. The current evidence does not provide a sufficient evidence base to explain what intervention or clinical attributes may influence the cost implications.

Original languageEnglish
Pages (from-to)82-90
Number of pages9
JournalEuropean Journal of Cardiovascular Nursing
Issue number1
Publication statusPublished - Feb 2016
Externally publishedYes


  • cost effectiveness
  • disease management
  • economic evaluation
  • healthcare expenditure
  • Heart failure
  • hospitalization

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