Paul L. Hebert, PhD; Jane E. Sisk, PhD; Jason J. Wang, PhD; Leah Tuzzio, MPH; Jodi M. Casabianca, MS; Mark R. Chassin, MD, MPP, MPH; Carol Horowitz, MD, MPH; Mary Ann McLaughlin, MD, MPH
Randomized, controlled trials have shown that nurse-led disease management for patients with heart failure can reduce hospitalizations. Less is known about the cost-effectiveness of these interventions.
To estimate the cost-effectiveness of a nurse-led disease management intervention over 12 months, implemented in a randomized, controlled effectiveness trial.
Cost-effectiveness analysis conducted alongside a randomized trial.
Medical costs from administrative records, and self-reported quality of life and nonmedical costs from patient surveys.
Patients with systolic dysfunction recruited from ambulatory clinics in Harlem, New York.
Societal and payer.
12-month program that involved 1 face-to-face encounter with a nurse and regular telephone follow-up.
Quality of life as measured by the Health Utilities Index Mark 3 and EuroQol-5D and cost-effectiveness as measured by the incremental cost-effectiveness ratio (ICER).
Costs and quality of life were higher in the nurse-managed group than the usual care group. The ICERs over 12 months were $17Â 543 per EuroQol-5Dâ€“based quality-adjusted life-year (QALY) and $15Â 169 per Health Utilities Index Mark 3â€“based QALY (in 2001 U.S. dollars).
From a payer perspective, the ICER ranged from $3673 to $4495 per QALY. Applying national prices in place of New York City prices yielded a societal ICER of $13Â 460 to $15Â 556 per QALY. Cost-effectiveness acceptability curves suggest that the intervention was most likely cost-effective for patients with less severe (New York Heart Association classes I to II) heart failure.
The trial was conducted in an ethnically diverse, inner-city neighborhood; thus, results may not be generalizable to other communities.
Over 12 months, the nurse-led disease management program was a reasonably cost-effective way to reduce the burden of heart failure in this community.
Hebert PL, Sisk JE, Wang JJ, Tuzzio L, Casabianca JM, Chassin MR, et al. Cost-Effectiveness of Nurse-Led Disease Management for Heart Failure in an Ethnically Diverse Urban Community. Ann Intern Med. ;149:540–548. doi: 10.7326/0003-4819-149-8-200810210-00006
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Published: Ann Intern Med. 2008;149(8):540-548.
Cardiology, Healthcare Delivery and Policy, Heart Failure, High Value Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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