• Manuel R Blum, Henning Øien, Harris L Carmichael, Paul Heidenreich, Douglas K Owens, and Jeremy D Goldhaber-Fiebert.
• Stanford University School of Medicine, Stanford, California, and Bern University Hospital and University of Bern, Bern, Switzerland (M.R.B.).
• Ann. Intern. Med. 2020 Feb 18; 172 (4): 248-257.

BackgroundPatients with heart failure (HF) discharged from the hospital are at high risk for death and rehospitalization. Transitional care service interventions attempt to mitigate these risks.ObjectiveTo assess the cost-effectiveness of 3 types of postdischarge HF transitional care services and standard care.DesignDecision analytic microsimulation model.Data SourcesRandomized controlled trials, clinical registries, cohort studies, Centers for Disease Control and Prevention life tables, Centers for Medicare & Medicaid Services data, and National Inpatient Sample (Healthcare Cost and Utilization Project) data.Target PopulationPatients with HF who were aged 75 years at hospital discharge.Time HorizonLifetime.PerspectiveHealth care sector.InterventionDisease management clinics, nurse home visits (NHVs), and nurse case management.Outcome MeasuresQuality-adjusted life-years (QALYs), costs, net monetary benefits, and incremental cost-effectiveness ratios (ICERs).Results Of Base Case AnalysisAll 3 transitional care interventions examined were more costly and effective than standard care, with NHVs dominating the other 2 interventions. Compared with standard care, NHVs increased QALYs (2.49 vs. 2.25) and costs ($81 327 vs. $76 705), resulting in an ICER of $19 570 per QALY gained.Results Of Sensitivity AnalysisResults were largely insensitive to variations in in-hospital mortality, age at baseline, or costs of rehospitalization. Probabilistic sensitivity analysis confirmed that transitional care services were preferred over standard care in nearly all 10 000 samples, at willingness-to-pay thresholds of $50 000 or more per QALY gained.LimitationTransitional care service designs and implementations are heterogeneous, leading to uncertainty about intervention effectiveness and costs when applied in particular settings.ConclusionIn older patients with HF, transitional care services are economically attractive, with NHVs being the most cost-effective strategy in many situations. Transitional care services should become the standard of care for postdischarge management of patients with HF.Primary Funding SourceSwiss National Science Foundation, Research Council of Norway, and an Intermountain-Stanford collaboration.

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