Ανάπτυξη μοντέλου κόστους-αποτελεσματικότητας για την αξιολόγηση εφαρμογής κινητής υγείας για την καρδιακή ανεπάρκεια

Abstract

The financial burden of heart failure on the English healthcare system, due to the frequent and lengthy hospitalisations, is significant. Clinical evidence suggest that telemonitoring, including mobile health, can reduce hospitalisations and improve self-care and quality of life in patients with heart failure. This thesis developed a cost-effectiveness model to assess a mobile health application for the management of heart failure from the National Health Service perspective. The cost-utility analysis compared the mHealth application combined with standard care versus standard care alone. A Markov cohort-state transition model was developed, and was populated with data identified in the literature. Deterministic and probabilistic sensitivity analyses were conducted to explore the impact of uncertainty in the input parameters on the model outcomes. The base case incremental cost-effectiveness ratio was estimated at £23,612 per quality-adjusted life year (QALY) gained, while the results of probabilistic sensitivity analysis indicated that mobile health was 39% and 69% likely to be cost-effective at a threshold of £20,000 per QALY and £30,000 per QALY, respectively. Patients using mobile health were projected to experience less hospitalisations due to heart failure, compared with patients receiving standard care alone over the time horizon. The one-way sensitivity analysis found the model results to be sensitive to variation in clinical parameters, such as mobile health effectiveness and compliance, suggesting the model was not robust to uncertainty. Nevertheless, the economic analysis found that mobile health in combination with current standard of care for the management of heart failure is a clinically effective alternative to the standard of care alone, albeit at higher cost.