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.