Cost‐Effectiveness of Virtual Health Coaching for Caregivers of Patients With Heart Failure: Results From a Randomized Controlled Trial

BACKGROUND: Informal caregivers play an important role in heart failure care. Health coaching can effectively help informal caregivers adopt healthy lifestyles to prevent and control diseases. However, the cost-effectiveness of interventions that support them remains unclear. We compare the cost-effectiveness of a virtual health coaching intervention (Virtual Caregiver Coach for You) designed to support caregivers in managing their stress by promoting self-care practices versus health information alone for informal caregivers of patients with heart failure. METHODS: In this randomized controlled trial, 250 informal caregivers were randomized (1:1) to receive Virtual Caregiver Coach for You plus health information, or health information alone, for 6 months. The incremental cost-effectiveness ratio was calculated as costs per quality-adjusted life-year gained over 12 months. A 2-part model was used to estimate health care costs, and nonparametric bootstrapping with 1000 resamples was used to represent incremental cost-effectiveness ratio uncertainty. RESULTS: Among the 165 caregivers in the primary analysis, the Virtual Caregiver Coach for You intervention improved quality-adjusted life-years by 0.035 (95% CI, 0.003-0.068). From a health care sector perspective, the intervention was dominant: lower hospitalization rates (5% versus 8%) fully offset the program's costs, yielding average savings of $77.45 (95% CI, $20.74-$134.17) per caregiver. At a $50 000 per quality-adjusted life-year threshold, the intervention was cost-effective in 99.7% of simulated scenarios. From a societal perspective, the overall cost was $29.71 per caregiver (95% CI, -$37.01 to $96.44). The incremental cost-effectiveness ratio was $838 per quality-adjusted life-year gained. CONCLUSIONS: Virtual Caregiver Coach for You can be a cost-effective intervention that improves the self-care and quality of life of informal caregivers of patients with heart failure. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03988621.