Análisis de coste-beneficio de los programas de prevención de reingresos en pacientes hospitalizados por insuficiencia cardíaca. Impacto económico de las nuevas formas de asistencia a la insuficiencia cardíaca

Prognosis of chronic heart failure (CHF) continues to be poor, in spite of recent advances lack in therapy. One of the main reasons for this persistent bad prognosis is the not application of recommended drug therapy, perhaps due, at least in part, to the great prevalence of CHF and the complexity of treatment. Disease management programs have shown to improve therapy and prognosis in patients with CHF, decreasing hospital admissions and improving survival. Nevertheless, the cost-benefit effect and the economic impact of such programs are not well known. We performed a prospective trial involving 153 consecutive patients diagnosed of heart failure in 1999 in our hospital, and randomized in two groups: the intervention (n=76) and the control group (n=77). The interventional program was based on the information and education of the patient and its surrounding and the possibillity of free telephonic or personal consultation with our cardiologist. Patients from the control group received usual care. After 15.8±6 months of follow-up, a significant reduction of mortality, heart failure readmissions and hospital stay were observed in the intervention group. The total number of days of hospital stay was 593 in the control group and 114 days in the intervention group, avoiding 479 days of hospital stay in this group. Given a cost of the hospital stay of 421.25 euros/day, the total cost eluded was 216 148.75 euros in 15.8 months, representing savings of 163 953.4 euros in one year. The expenses of the program were 2645.91 euros/month, resulting in savings of 132 202.48 euros/year. In conclusion, the cost to benefit ratio of our program is favorable.