Economic Evaluation of Nurse-led HF Disease Management
Economic Evaluation of Nurse-led HF Disease Management
Background Although previously conducted meta-analyses suggest that nurse-led disease management programs in heart failure (HF) can improve patient outcomes, uncertainty regarding the cost-effectiveness of such programs remains.
Methods To compare the relative merits of 2 variants of a nurse-led disease management program (basic or intensive support by a nurse specialized in the management of patients with HF) against care as usual (routine follow-up by a cardiologist), a trial-based economic evaluation was conducted alongside the COACH study.
Results In terms of costs per life-year, basic support was found to dominate care as usual, whereas the incremental cost-effectiveness ratio between intensive support and basic support was found to be equal to ¢532,762 per life-year; in terms of costs per quality-adjusted life-year (QALY), basic support was found to dominate both care as usual and intensive support. An assessment of the uncertainty surrounding these findings showed that, at a threshold value of ¢20,000 per life-year/¢20,000 per QALY, basic support was found to have a probability of 69/62% of being optimal against 17/30% and 14/8% for care as usual and intensive support, respectively. The results of our subgroup analysis suggest that a stratified approach based on offering basic support to patients with mild to moderate HF and intensive support to patients with severe HF would be optimal if the willingness-to-pay threshold exceeds ¢45,345 per life-year/¢59,289 per QALY.
Conclusions Although the differences in costs and effects among the 3 study groups were not statistically significant, from a decision-making perspective, basic support still had a relatively large probability of generating the highest health outcomes at the lowest costs. Our results also substantiated that a stratified approach based on offering basic support to patients with mild to moderate HF and intensive support to patients with severe HF could further improve health outcomes at slightly higher costs.
With readmission rates varying between 13% and 50% over a period ranging from 15 days to 6 months, respectively, recurrent hospitalization in patients with heart failure (HF) poses an increasing demand on the scarce health care resources. In addition, mortality after hospitalization for acute HF reaches up to 18.7% within the first 6 months after hospital discharge. These alarming event rates provide ample justification for identifying opportunities to improve quality of care and treatment compliance and to lower the rates of hospital readmission.
Because of an increasing demand on health care services, provision of patient care by specialized nurses is on the rise in several Western nations. The results of previously published meta-analyses suggest that nurse-led disease management programs can indeed improve clinical outcome and quality of life in patients with HF. However, until now, only few articles have addressed the important question of whether such programs can produce these favorable effects in an affordable manner.
The aim of the present study was to assess whether the nurse-led disease management programs from the COACH study were cost-effective. To our knowledge, no cost-effectiveness analysis has yet been conducted alongside such a large-scale, multicenter trial in which different levels of intensity for nurse-led management of patients with HF were compared against routine follow-up visits to a cardiologist.
Abstract and Introduction
Abstract
Background Although previously conducted meta-analyses suggest that nurse-led disease management programs in heart failure (HF) can improve patient outcomes, uncertainty regarding the cost-effectiveness of such programs remains.
Methods To compare the relative merits of 2 variants of a nurse-led disease management program (basic or intensive support by a nurse specialized in the management of patients with HF) against care as usual (routine follow-up by a cardiologist), a trial-based economic evaluation was conducted alongside the COACH study.
Results In terms of costs per life-year, basic support was found to dominate care as usual, whereas the incremental cost-effectiveness ratio between intensive support and basic support was found to be equal to ¢532,762 per life-year; in terms of costs per quality-adjusted life-year (QALY), basic support was found to dominate both care as usual and intensive support. An assessment of the uncertainty surrounding these findings showed that, at a threshold value of ¢20,000 per life-year/¢20,000 per QALY, basic support was found to have a probability of 69/62% of being optimal against 17/30% and 14/8% for care as usual and intensive support, respectively. The results of our subgroup analysis suggest that a stratified approach based on offering basic support to patients with mild to moderate HF and intensive support to patients with severe HF would be optimal if the willingness-to-pay threshold exceeds ¢45,345 per life-year/¢59,289 per QALY.
Conclusions Although the differences in costs and effects among the 3 study groups were not statistically significant, from a decision-making perspective, basic support still had a relatively large probability of generating the highest health outcomes at the lowest costs. Our results also substantiated that a stratified approach based on offering basic support to patients with mild to moderate HF and intensive support to patients with severe HF could further improve health outcomes at slightly higher costs.
Introduction
With readmission rates varying between 13% and 50% over a period ranging from 15 days to 6 months, respectively, recurrent hospitalization in patients with heart failure (HF) poses an increasing demand on the scarce health care resources. In addition, mortality after hospitalization for acute HF reaches up to 18.7% within the first 6 months after hospital discharge. These alarming event rates provide ample justification for identifying opportunities to improve quality of care and treatment compliance and to lower the rates of hospital readmission.
Because of an increasing demand on health care services, provision of patient care by specialized nurses is on the rise in several Western nations. The results of previously published meta-analyses suggest that nurse-led disease management programs can indeed improve clinical outcome and quality of life in patients with HF. However, until now, only few articles have addressed the important question of whether such programs can produce these favorable effects in an affordable manner.
The aim of the present study was to assess whether the nurse-led disease management programs from the COACH study were cost-effective. To our knowledge, no cost-effectiveness analysis has yet been conducted alongside such a large-scale, multicenter trial in which different levels of intensity for nurse-led management of patients with HF were compared against routine follow-up visits to a cardiologist.
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