Abstract

Background

Left ventricular assist device (LVAD) implantation improves outcomes in advanced heart failure, however, the optimal frequency of outpatient assessments to improve cost-effectiveness and potentially avert readmissions is unclear.

Methods

To test if varying the frequency of follow-up after LVAD implantation reduces readmissions and improves cost-effectiveness, a less intensive follow-up (LIFU) strategy with scheduled visits at 1 month and then every 6 months was compared to an intensive follow-up (IFU) group with scheduled visits at 1, 2, and 4 weeks, and then every 3 months post-implant. We developed a decision-tree model to evaluate the cost-effectiveness of different follow-up schedules at 3, 6, and 12-months. The readmission rates for LIFU and IFU, along with the associated costs, were estimated using data from the IBM MarketScan Commercial Claims Databases (2015–2018). A total of 349 patients were enrolled, with 193 and 156 in the IFU and LIFU groups.

Results

Patients with IFU were found to have a lower risk for readmission at 3 months (HR: 0.69, 95% confidence interval (CI): 0.60–0.79), but this difference diminished overtime at 6 months (HR: 0.84, 95% CI: 0.73–0.96) and 12 months (HR: 0.94, 95% CI: 0.83–1.06). The incremental net benefit of IFU, when compared with LIFU, is greatest in the first 3 months and also diminishes over time (3 months: $19616, 6 months $9257, 12 months $717).

Conclusions

An initial IFU strategy, followed by a period of de-escalation at the 6-month post-implant mark in lower-risk patients, may be a more cost-effective strategy to provide follow-up care while not predisposing patients to a higher risk of readmission.

中文翻译：

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左心室辅助装置随访的多种方法可提高成本效益

摘要

背景

左心室辅助装置 (LVAD) 植入可改善晚期心力衰竭的结果，但是，门诊评估的最佳频率以提高成本效益和潜在避免再入院尚不清楚。

方法

为了测试在 LVAD 植入后改变随访频率是否能减少再入院率并提高成本效益，将安排在 1 个月然后每 6 个月一次的低强度随访 (LIFU) 策略与强化随访进行比较(IFU) 组，在植入后 1、2 和 4 周安排就诊，然后每 3 个月进行一次。我们开发了一个决策树模型来评估在 3、6 和 12 个月时不同随访计划的成本效益。LIFU 和 IFU 的再入院率以及相关成本是使用 IBM MarketScan 商业索赔数据库（2015-2018 年）中的数据估算的。共纳入 349 名患者，其中 IFU 和 LIFU 组分别为 193 和 156 名。

结果

发现 IFU 患者在 3 个月时再入院的风险较低（HR：0.69，95% 置信区间 (CI)：0.60–0.79），但随着时间的推移，这种差异在 6 个月时逐渐减小（HR：0.84，95% CI： 0.73–0.96) 和 12 个月（HR：0.94，95% CI：0.83–1.06）。与 LIFU 相比，IFU 的增量净收益在前 3 个月最大，并且随着时间的推移逐渐减少（3 个月：19616 美元，6 个月 9257 美元，12 个月 717 美元）。

结论

最初的 IFU 策略，然后在低风险患者植入后 6 个月时逐步降级，可能是一种更具成本效益的策略，可提供后续护理，同时不会使患者易患高风险的重新入院。