RESUMO
PURPOSE: To assess the cost-utility of adding a disease management program (DMP) delivered by geriatric day hospital (GDH) for older patients with heart failure (HF) after hospital discharge. METHODS: 117 older HF patients discharged by a geriatric service were randomly assigned to DMP (n = 59) and usual care (UC) (n = 58) groups. The DMP group received health education, therapeutic control and monitoring through both telephone contacts and face-to-face visits at the GDH for 12 months. The UC group received standard health care. The main outcome measures were the costs from the health-care system and societal perspectives and quality-adjusted life-years (QALYs) using EuroQol (EQ-5D-3L). The cost-effectiveness analysis used the package ICEinfer in R 2.13.0. RESULTS: The mean age was 85 years, and 73% of the patients were women. The mean values of QALYs after 12 months were - 0.083 in DMP and - 0.154 in UC. Each extra QALY gained by the DMP relative to usual care cost was 38,274 and 25,390 from health-care or societal perspective, respectively. An investment of 44,000/QALY (Spanish Health System Threshold) showed a 91 and 85% of probability to be cost-effective from health-care and societal perspectives. CONCLUSION: The intervention was moderately cost-effective in delaying deaths and preserving the loss of health-related quality of life in older patients with HF. The study was internationally registered with the ISRCTN10823032.
RESUMO
BACKGROUND: The aim of the present study was to identify the physical fitness (PF) tests of a multi-component battery more related to the perception of problems in each dimension of the health-related quality of life (HRQoL) assessed by the EuroQol 5 dimensions 3 level questionnaire (EQ-5D-3L) in community-dwelling middle-aged and older adults METHODS: A cross-sectional study was conducted with 7104 participants (6243 females and 861 males aged 50-99 years) who were recruited in the framework of the Exercise Looks After You Program, which is a public health program designed to promote physical activity (PA) in community-dwelling middle-aged and older adults. Participants were assessed by the EQ-5D-3L questionnaire and a battery of fitness tests. The responses to each EQ-5D-3L dimension were collapsed into a two-tier variable consisting of «perceive problems¼ and «do not perceive problems¼. Correlation coefficients for the relationships between the HRQoL variables, between the PF variables, and between the HRQoL and PF variables were obtained. Two logistic regression models, one adjusted and one unadjusted, were developed for each EQ-5D-3L dimension. RESULTS: There were significant correlations between all variables except anxiety/depression and the back scratch test. The PF tests that correlated best with the HRQoL dimensions were the Timed Up-and-Go Test (TUG) and the 6-min walk; pain/discomfort and anxiety/depression correlated less well. All PF tests correlated, especially the TUG and 6-min walk tests. Unadjusted logistic models showed significant goodness of fit for the mobility and pain/discomfort dimensions only. Adjusted logistic models showed significant goodness of fit for all dimensions when the following potential confounding variables were included: age, gender, weekly level of PA, smoking and alcohol habits, body mass index, and educational level. For all dimensions, the highest odds ratios for the association with PF tests were with the TUG; this was observed with both the unadjusted and adjusted models. CONCLUSIONS: The perception of problems, as measured by the EQ-5D-3L dimensions, was associated with a lower level of fitness, particularly for those dimensions that relate more closely to physical components. The PF tests that associated most closely with the perception of problems in the HRQoL dimensions were the TUG and the 6-min walk. This information will aid the design and assessment of PA programs that aim to improve HRQoL.
