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.
Paul L. Hebert, Jane E. Sisk, Jason J. Wang, Leah Tuzzio, Jodi M. Casabianca, Mark R. Chassin, et al. Cost-Effectiveness of Nurse-Led Disease Management for Heart Failure in an Ethnically Diverse Urban Community. Ann Intern Med. 2008;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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