Costing a Nurse and Social Worker Palliative Telecare Intervention for People with Chronic Heart and Lung Diseases (RP304)

Outcomes 1. Explain methods for evaluating the costs and benefits of a clinical palliative care intervention.2. Apply the results of this economic analysis to engage stakeholders considering implementing a similar intervention. Key Message A nurse and social worker palliative telecare team improved quality of life, depression, anxiety, and disease-specific health status for patients with heart failure (HF), chronic obstructive pulmonary disease (COPD), and interstitial lung disease for a relatively low cost. Importance In a randomized clinical trial, people with heart failure (HF), chronic obstructive pulmonary disease (COPD), and interstitial lung disease who received a nurse and social worker palliative telecare team intervention had improvements in quality of life, depression, anxiety, and disease-specific health status at 6 months. Understanding intervention costs will inform dissemination and implementation of the intervention. Objective(s) Describe the total cost and incremental costs per 1-unit improvement in outcomes of a palliative telecare team intervention. Scientific Methods Utilized Per-patient costs were calculated using personnel time-based activity costing which research staff prospectively recorded throughout the study. Time was multiplied by hourly mean wages from the US Bureau of Labor Statistics. Effectiveness was defined as the difference between the intervention and control groups in change from baseline to 6 months on self-report measures. Incremental costs per change in outcome were calculated; a 1-unit change was defined as 1 minimal clinically important difference on the measure used. Results The mean total cost of the intervention per patient was $1,139.68 US dollars (SD $368.15). Mean disaggregated costs by personnel were 10.02 hours ($448.05) for the nurse, 6.63 hours ($207.76) for the social worker, and 38 minutes ($79.11) on average per collaborating physician (primary care, palliative care, cardiologist, pulmonologist). The incremental costs per change in clinical outcomes were: $247.76 (95%CI $116.27-$379.24) for quality of life, $482.92 (95%CI $164.17-$801.66) for depression, $476.85 (95%CI $153.91-$799.79) for anxiety, $160.97 (95%CI $106.91-$215.03) for HF-specific health status, and $3,561.50 (95%CI $1,994.89-$5,128.11) for COPD-specific health status. Conclusion(s) This palliative telecare team produced clinically meaningful changes in quality of life for a relatively low cost, potentially justifying dissemination. Impact Estimates of personnel time and costs associated with this effective palliative care intervention can inform decision-makers considering implementation. Keywords Models of palliative/hospice care delivery/Economic evaluations