Cost-Benefit Analysis of Heart failure clinic implementation: The case of Belgian healthcare providers

Abstract

Heart failure (HF) is a major worldwide epidemic associated with high morbidity and mortality rates. The prevalence of HF is approximately 1–2% of the adult population in developed countries, rising to over 10% amongst people over the age of 65(81). In Belgium, over 200,000 people live with heart failure and there are 15,000 new cases yearly diagnosed. This has created a significant burden on the regional and national healthcare system, social costs, and impact on HF patients' and families' quality of life. The total cost of heart failure was projected to be around EUR 781 million, devouring an estimated 2% of the Belgian national healthcare budget. Traditionally, HF patients are diagnosed and treated in the cardiology department of most hospitals; however, it is believed that this approach is not reducing mortality rates, rehospitalizations, and poor quality of life. This results in an excessive cost burden on the patient and the healthcare system as the HF patients are not followed up in optimal care. Cardiologists believe that HF clinics offer more improved care management pathways for HF patients with a positive impact on treatment outcomes, they claim that the implementation of Heart Failure clinics leads to improvement in the quality of life of HF patients, reduces mortality rates, decreases readmissions or rehospitalization, and reduces the social cost of the disease. Some studies support the assertion of the cardiologist that heart failure patients treated in a Heart Failure (HF) clinic have better clinical outcomes. Even with the significant evidence of the impact of Heart Failure clinics clinicians are struggling to implement the HF clinic at their hospitals. The guidelines issued by the European Society of Cardiology in support of the implementation of integrated multidisciplinary Heart Failure clinics for managing Heart Failure are broad and do not specify a definite approach to the implementation of the HF clinic. There is no formal recognition of HF specialism for healthcare professionals in Belgium(1). And, the lack of HF nurse training and employment reimbursement further impedes the efforts of clinicians to build the HF clinic with an adequate HF healthcare workforce in their hospitals. The ESC guidelines do not specify the exact approach to implementing the HF clinic, therefore there is a diverse interpretation of what HF clinics are, what services they should provide, and the patient pathway, leading to a situation where different providers are implementing or viewing HF clinics from a diverse perspective. Clinicians willing to set up the HF clinic in their hospital run into the problem of not being able to present a strong case from a business plan perspective to support the need to implement the HF clinic. This report seeks to assist the clinicians in defining what an HF clinic is, the patient pathways, and implementing an HF clinic from a cost-benefit point of view that fits into the existing healthcare system. The report identified that healthcare providers seeking to develop an HF clinic need to look at the clinic from a value-based healthcare approach with an integrated multidisciplinary model to organize the clinic, where the value proposition for the patients' outcomes is compared with the cost of establishing the clinic. HF clinics can be implemented at incremental levels, with the HF specialist cardiologist and HF specialist nurse as the critical resources at the center of the clinic's performance. The implementation model has clearly defined KPIs for HF clinics to measure and report the impacts of the clinic from a healthcare provider and patient perspective to justify and highlight the value-driven approach. These measurements are defined to support the evidence of HF clinic's treatment improvement and follow-up reduction in all-cause mortality, readmission rate, and improved quality of life compared with usual cardiology care. The cost-benefit analysis demonstrates that the HF clinic creates opportunities for the hospital, even at the first level of implementation with the HF specialist and the HF nurse. The HF clinic benefits from cost and capacity offload (from the specialist cardiologist to the HF nurse) to see more HF patients in the clinics and, as a result, generate incremental value from additional services and treatments of following up the HF patient in a proactive preventive approach. When implementing the HF clinic, there is a need to consider the cost-benefit analysis in terms of the capacity and resource implications of setting up the clinic. Given the variety of conditions of the hospitals in terms of resources and readiness, it is possible to start implementation from a segregated consultation (specific time allocation from a shared resource to the clinic) and grow in terms of complexity and services provided for the patients. Following the proposed incremental building block implementation approach will minimize the impact of the additional resources and increase capacity, delivering additional value for the healthcare provider at each step due to the incremental number of patients attended and services provided by the clinic. In conclusion, the cost-benefit analysis supports the transition from the traditional HF care management approach to a clearly defined value-based integrated multidisciplinary HF clinic because of the cost minimization of consultation without diminishing the quality of consultation, the potential incremental revenue stream from additional patients and services provided, and the cost avoidance in patient rehospitalization freeing up bed occupancy. At the same time, it provides a customizable approach for healthcare providers to start the implementation according to their specific conditions taking advantage of the incremental value creation without making an impact on their operational costs.