Donald S Shepard, Jiaye Shen, Blair K Yant, Deborah E Denkmann, Patrick D Savage, Robin K Collier, Brian R Katz, Philip A Ades, Diann E Gaalema
{"title":"增加心脏康复参与的病例管理和财政激励的成本效益。","authors":"Donald S Shepard, Jiaye Shen, Blair K Yant, Deborah E Denkmann, Patrick D Savage, Robin K Collier, Brian R Katz, Philip A Ades, Diann E Gaalema","doi":"10.1097/HCR.0000000000000952","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>As cardiac rehabilitation (CR) is highly effective, cost-effective, and professionally recommended, policymakers seek to increase utilization. Here we applied results from a randomized trial of case management (CM) and financial incentives (FI), paid as retail gift cards, separately and combined. We modeled their impact and cost-effectiveness compared to usual care (UC) in increasing quality-adjusted life years (QALYs).</p><p><strong>Methods: </strong>Staff time logs, FI payouts, and CR attendance records generated short-term data. We derived the lifetime QALYs and cost-effectiveness (in 2022 US dollars) from a 2024 cost-effectiveness study of CR calibrated from an observational cohort of 601 099 CR-eligible Medicare beneficiaries. That cohort study controlled for confounding using instrumental variables (IV) and propensity-based (PB) matching.</p><p><strong>Results: </strong>The FI alone and CM + FI combined interventions increased CR sessions significantly. Additional CR sessions per participant averaged 7.04 (95% CI, 0.93-13.15) with FI and 13.63 (95% CI, 7.86-19.41) with CM + FI. The CM alone intervention did not increase sessions significantly (mean = 1.53: 95% CI, -4.23 to 7.56). The CM + FI intervention generated the most lifetime QALYs, 0.733 (IV) and 1.100 (PB), and displayed a powerful synergy between CM and FI. Under CM + FI, the cost of financial payouts averaged $1088 (range $0-$1966), and total intervention costs averaged $2388. The lifetime cost-effectiveness of CM + FI was 29.966 (95% CI, 29.636-30.296, IV) or 29.257 (95% CI, 28.935-29.579 PB) QALYs/$million. Both values substantially surpassed the average threshold of the United States health care system (10.421 QALYs/$million).</p><p><strong>Conclusions: </strong>The CM + FI intervention proved highly effective and more than twice as cost-effective as the average of all health interventions in the United States. Thus, CM + FI, combined with other effective interventions such as automatic referral and home-based CR, merit widespread implementation and funding.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cost-Effectiveness of Case Management and Financial Incentives to Increase Participation in Cardiac Rehabilitation.\",\"authors\":\"Donald S Shepard, Jiaye Shen, Blair K Yant, Deborah E Denkmann, Patrick D Savage, Robin K Collier, Brian R Katz, Philip A Ades, Diann E Gaalema\",\"doi\":\"10.1097/HCR.0000000000000952\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>As cardiac rehabilitation (CR) is highly effective, cost-effective, and professionally recommended, policymakers seek to increase utilization. Here we applied results from a randomized trial of case management (CM) and financial incentives (FI), paid as retail gift cards, separately and combined. We modeled their impact and cost-effectiveness compared to usual care (UC) in increasing quality-adjusted life years (QALYs).</p><p><strong>Methods: </strong>Staff time logs, FI payouts, and CR attendance records generated short-term data. We derived the lifetime QALYs and cost-effectiveness (in 2022 US dollars) from a 2024 cost-effectiveness study of CR calibrated from an observational cohort of 601 099 CR-eligible Medicare beneficiaries. That cohort study controlled for confounding using instrumental variables (IV) and propensity-based (PB) matching.</p><p><strong>Results: </strong>The FI alone and CM + FI combined interventions increased CR sessions significantly. Additional CR sessions per participant averaged 7.04 (95% CI, 0.93-13.15) with FI and 13.63 (95% CI, 7.86-19.41) with CM + FI. The CM alone intervention did not increase sessions significantly (mean = 1.53: 95% CI, -4.23 to 7.56). The CM + FI intervention generated the most lifetime QALYs, 0.733 (IV) and 1.100 (PB), and displayed a powerful synergy between CM and FI. Under CM + FI, the cost of financial payouts averaged $1088 (range $0-$1966), and total intervention costs averaged $2388. The lifetime cost-effectiveness of CM + FI was 29.966 (95% CI, 29.636-30.296, IV) or 29.257 (95% CI, 28.935-29.579 PB) QALYs/$million. Both values substantially surpassed the average threshold of the United States health care system (10.421 QALYs/$million).</p><p><strong>Conclusions: </strong>The CM + FI intervention proved highly effective and more than twice as cost-effective as the average of all health interventions in the United States. Thus, CM + FI, combined with other effective interventions such as automatic referral and home-based CR, merit widespread implementation and funding.</p>\",\"PeriodicalId\":15192,\"journal\":{\"name\":\"Journal of Cardiopulmonary Rehabilitation and Prevention\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-05-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiopulmonary Rehabilitation and Prevention\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/HCR.0000000000000952\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiopulmonary Rehabilitation and Prevention","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/HCR.0000000000000952","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Cost-Effectiveness of Case Management and Financial Incentives to Increase Participation in Cardiac Rehabilitation.
Purpose: As cardiac rehabilitation (CR) is highly effective, cost-effective, and professionally recommended, policymakers seek to increase utilization. Here we applied results from a randomized trial of case management (CM) and financial incentives (FI), paid as retail gift cards, separately and combined. We modeled their impact and cost-effectiveness compared to usual care (UC) in increasing quality-adjusted life years (QALYs).
Methods: Staff time logs, FI payouts, and CR attendance records generated short-term data. We derived the lifetime QALYs and cost-effectiveness (in 2022 US dollars) from a 2024 cost-effectiveness study of CR calibrated from an observational cohort of 601 099 CR-eligible Medicare beneficiaries. That cohort study controlled for confounding using instrumental variables (IV) and propensity-based (PB) matching.
Results: The FI alone and CM + FI combined interventions increased CR sessions significantly. Additional CR sessions per participant averaged 7.04 (95% CI, 0.93-13.15) with FI and 13.63 (95% CI, 7.86-19.41) with CM + FI. The CM alone intervention did not increase sessions significantly (mean = 1.53: 95% CI, -4.23 to 7.56). The CM + FI intervention generated the most lifetime QALYs, 0.733 (IV) and 1.100 (PB), and displayed a powerful synergy between CM and FI. Under CM + FI, the cost of financial payouts averaged $1088 (range $0-$1966), and total intervention costs averaged $2388. The lifetime cost-effectiveness of CM + FI was 29.966 (95% CI, 29.636-30.296, IV) or 29.257 (95% CI, 28.935-29.579 PB) QALYs/$million. Both values substantially surpassed the average threshold of the United States health care system (10.421 QALYs/$million).
Conclusions: The CM + FI intervention proved highly effective and more than twice as cost-effective as the average of all health interventions in the United States. Thus, CM + FI, combined with other effective interventions such as automatic referral and home-based CR, merit widespread implementation and funding.
期刊介绍：
JCRP was the first, and remains the only, professional journal dedicated to improving multidisciplinary clinical practice and expanding research evidence specific to both cardiovascular and pulmonary rehabilitation. This includes exercise testing and prescription, behavioral medicine, and cardiopulmonary risk factor management. In 2007, JCRP expanded its scope to include primary prevention of cardiovascular and pulmonary diseases. JCRP publishes scientific and clinical peer-reviewed Original Investigations, Reviews, and Brief or Case Reports focused on the causes, prevention, and treatment of individuals with cardiovascular or pulmonary diseases in both a print and online-only format. Editorial features include Editorials, Invited Commentaries, Literature Updates, and Clinically-relevant Topical Updates. JCRP is the official Journal of the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation.
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