Effectiveness and Cost-Effectiveness of Case Management in Advanced Heart Failure Patients Attended in Primary Care: A Systematic Review and Meta-Analysis

Caterina Checa (), Carlos Canelo-Aybar, Stefanie Suclupe, David Ginesta-López, Anna Berenguera, Xavier Castells, Carlos Brotons and Margarita Posso
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Caterina Checa: Doctoral Program in Methodology of Biomedical Research, Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain
Carlos Canelo-Aybar: Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025 Barcelona, Spain
Stefanie Suclupe: Department of Clinical Epidemiology and Public Health, de la Santa Creu i Sant Pau (IIB Sant Pau) University Hospital, 08041 Barcelona, Spain
David Ginesta-López: Primary Healthcare Centre Dreta de l’Eixample, 08013 Barcelona, Spain
Anna Berenguera: Doctoral Program in Methodology of Biomedical Research, Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain
Xavier Castells: Doctoral Program in Methodology of Biomedical Research, Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain
Carlos Brotons: Biomedical Research Institute (IBB Sant Pau), Sardenya Primary Health Care Center, 08025 Barcelona, Spain
Margarita Posso: Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain

IJERPH, 2022, vol. 19, issue 21, 1-22

Abstract: Aims: Nurse-led case management (CM) may improve quality of life (QoL) for advanced heart failure (HF) patients. No systematic review (SR), however, has summarized its effectiveness/cost-effectiveness. We aimed to evaluate the effect of such programs in primary care settings in advanced HF patients. We examined and summarized evidence on QoL, mortality, hospitalization, self-care, and cost-effectiveness. Methods and results: The MEDLINE, CINAHL, Embase, Clinical Trials, WHO, Registry of International Clinical Trials, and Central Cochrane were searched up to March 2022. The Consensus Health Economic Criteria instrument to assess risk-of-bias in economic evaluations, Cochrane risk-of-bias 2 for clinical trials, and an adaptation of Robins-I for quasi-experimental and cohort studies were employed. Results from nurse-led CM programs did not reduce mortality (RR 0.78, 95% CI 0.53 to 1.15; participants = 1345; studies = 6; I 2 = 47%). They decreased HF hospitalizations (HR 0.79, 95% CI 0.68 to 0.91; participants = 1989; studies = 8; I 2 = 0%) and all-cause ones (HR 0.73, 95% CI 0.60 to 0.89; participants = 1012; studies = 5; I 2 = 36%). QoL improved in medium-term follow-up (SMD 0.18, 95% CI 0.05 to 0.32; participants = 1228; studies = 8; I 2 = 28%), and self-care was not statistically significant improved (SMD 0.66, 95% CI −0.84 to 2.17; participants = 450; studies = 3; I 2 = 97%). A wide variety of costs ranging from USD 4975 to EUR 27,538 was observed. The intervention was cost-effective at ≤EUR 60,000/QALY. Conclusions: Nurse-led CM reduces all-cause hospital admissions and HF hospitalizations but not all-cause mortality. QoL improved at medium-term follow-up. Such programs could be cost-effective in high-income countries.

Keywords: case management; advanced heart failure; cost-effectiveness; meta-analyses; mortality; quality of life; hospital admissions; self-care (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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