Key result
Cardiac Care Bridge program shows no benefit over usual care for readmission or mortality.
Why the study?
The cost-effectiveness of the Cardiac Care Bridge nurse-led transitional care program in older high-risk cardiac patients compared to usual care was unknown.
Does the Cardiac Care Bridge transitional care program improve clinical outcomes and cost-effectiveness in older high-risk cardiac patients compared to usual care?
RCT (n=306)
Single-blind
Web-based program
Yes
Does the Cardiac Care Bridge transitional care program improve clinical outcomes and cost-effectiveness in older high-risk cardiac patients compared to usual care?
Effect estimate: RD 6% (95% CI -5 to 18)
Absolute Event Rate: 54% vs 48%
The Cardiac Care Bridge transitional care program was not cost-effective and resulted in fewer QALYs compared to usual care in older high-risk cardiac patients.
Avoid Cardiac Care Bridge transitional care; challenges assumptions of benefit and cost-effectiveness in high-risk older cardiac patients.
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.
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Petri et al. (2022) conducted an RCT in Cardiac disease at high risk of readmission and mortality (n=306). Cardiac Care Bridge (CCB) transitional care program vs. Usual care was evaluated on Composite of first all-cause unplanned hospital readmission or mortality within six months (RD 6%, 95% CI -5 to 18). The Cardiac Care Bridge transitional care program did not significantly reduce the composite outcome of first unplanned readmission or mortality compared to usual care (54% vs 48%, RD 6%) and was not cost-effective.
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