Evaluation of the epidemiological and economic impact of the ADLIFE intervention on medium-to long-term in patients with advanced chronic disease

Igor Larrañaga^1,2,3*Javier Mar^1,3Ania Gorostiza¹Borja García-Lorenzo^1,2Beñat Zubeltzu⁴Remedios Vega⁵Rachelle Kaye⁶Gil Levy⁶Olga Vishnevetsky⁶Rikke Lyngholm Christensen⁷Anne Dichmann Sorknæs⁸Natassia Garton⁹Anne Swoboda¹⁰Fritz Arndt¹⁰Lisa McCann¹¹Roma Maguire¹¹Morven Miller¹¹Gokce B Laleci Erturkmen¹²Mustafa Yuksel¹²Theodoros N Arvanitis¹³Chao Tong¹³Jose I Aznar-Baranda¹⁴Jessica Caballero¹⁴Nerea González^1,15,2Juan de la Torre Prados¹Dolores Verdoy^1,2Esteban de Manuel Keenoy¹Ane Fullaondo^1,2

• ¹Biosistemak Institute for Health Systems Research, Bilbao, Spain
• ²Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Bilbao, Spain
• ³Research Unit, Debagoiena Integrated Healthcare Organisation, Osakidetza-Basque Health Service, Arrasate-Mondragón, Spain
• ⁴Donostialdea Integrated Healthcare Organisation, Osakidetza-Basque Health Service, Donostia-San Sebastián, Spain
• ⁵Tolosaldea Integrated Healthcare Organisation, Osakidetza-Basque Health Service, Tolosa, Spain
• ⁶Assuta Medical Centre Ashdod, Ashdod, Israel
• ⁷Centre for Innovative Medical Technology (CIMT), Odense University Hospital, Odense, Denmark
• ⁸Emergency & Medical Department, Svendborg Hospital, Odense University Hospital & University of Southern Denmark, Svendborg, Denmark
• ⁹University Hospitals Coventry & Warwickshire, NHS Trust, Coventry, United Kingdom
• ¹⁰Gesunder Werra-Meißner-Kreis GmbH, Eschwege, Germany
• ¹¹Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
• ¹²SRDC, Ankara, Türkiye
• ¹³Department of Electronic, Electrical and Systems Engineering, University of Birmingham, Birmingham, United Kingdom
• ¹⁴NTT Data Spain, Bilbao, Spain
• ¹⁵Research Unit, Galdakao-Usansolo University Hospital, Barrualde-Galdakao Integrated Healthcare Organisation, Osakidetza-Basque Health Service, Galdakao, Spain

Introduction Patients with advanced chronic disease (ACD) experience transitions in their clinical stability, leading to increased healthcare resource use and costs. EU-funded ADLIFE digital intervention aimed to ensure their quality of life through individualised care plans, clinical decision-making support, and patient empowerment. This study assessed the impact and sustainability of ADLIFE. Method Target population included patients aged ≥55 years with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD). First, a discrete event simulation (DES) model was developed using data from Osakidetza-Basque Health Service to represent the natural history of the disease. Second, ADLIFE intervention was implemented in four pilot sites: Spain, England, Israel and Denmark. Intervention effect was quantified by comparing resource use between control and intervention groups. Finally, a budget impact analysis (BIA) was conducted by extrapolating the burden of the disease to 2030 under two scenarios: conventional and ADLIFE. Results ADFLIFE intervention involved 370 patients (185 intervention, 185 control). Emergency visits and consultations with primary care professionals decreased significantly, while specialist consultations increased. Depending on the pilot site, projections estimated that ACD prevalence will increase by 37%-50% by 2030, increasing associated costs. Under the ADLIFE scenario, the burden of the disease could be reduced by 1%-2%, resulting in cumulative savings of €4-58 million. Discussion Projections indicated a major challenge ahead due to a rise in ACD prevalence, highlighting the need for timely and effective healthcare responses. ADLIFE improved patient care and resource management, and its adoption could help reduce the disease burden and generate sustained long-term savings.