Abstract 4139249: Cost or Benefit? Analysis of a Virtual Health Coaching Intervention for Caregivers of Patients with Heart Failure

Background: Despite the large role of informal caregivers in heart failure (HF) care, the cost-effectiveness of interventions supporting informal caregivers of patients with HF is unclear. Aim: Compare the cost-effectiveness of a virtual health coaching intervention ("ViCCY,” Virtual Caregiver Coach for You) designed to improve self-care vs. health information alone for informal caregivers of patients with HF. Methods: In this randomized controlled trial, 250 informal caregivers were randomized in a 1:1 ratio to receive a combination of ViCCY and health information or health information only for 6 months. Caregiver healthcare utilization (i.e., hospitalization, emergency visits, ambulance use, diagnostic/therapeutic procedures, and home care) was self-reported at 1, 3, 6, 9, and 12 months after randomization. Incremental cost-effectiveness ratio (ICER) was calculated as incremental costs per quality-adjusted life-year (QALY) within the 12-month trial period. Both unadjusted and adjusted regression analyses were used to measure healthcare utilization and cost. Primary analyses were conducted on the 164 caregivers with complete data on both QALY and healthcare costs. Sensitivity analyses were conducted on samples with complete data for either QALY or healthcare costs. Calculations were made to estimate the ICER for a hypothetical scaled version of the intervention, with 12 health coaches serving 336 informal caregivers per year, including training and fidelity costs. Results: The intervention improved QALYs by 0.036 at a cost of $862.4 per caregiver for an ICER of $23,956 for the ViCCY group (Table). The overall effect of the ViCCY intervention was a reduction of $1,114.8 in healthcare spending, which was mainly driven by lower utilization and costs associated with hospitalization. The results were robust to sensitivity analyses. Scaling the intervention could lead to even greater gains. Conclusions: At a conservative threshold of US$50,000/QALYS, these findings indicate that ViCCY can be a cost-effective and affordable way of enhancing the self-care of informal caregivers of patients with HF while simultaneously reducing caregiver healthcare costs, particularly the costs associated with caregiver hospitalization.