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
Grant Support: Dr. Sisk was supported by a grant from the Agency for Healthcare Research and Quality (R01 HS10402-01).
Potential Financial Conflicts of Interest:Grants received: C. Horowitz (National Institutes of Health).
Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Hebert (e-mail, Paul.Hebert2@va.gov). Data set: Not available.
Requests for Single Reprints: Paul L. Hebert, PhD, Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101.
Current Author Addresses: Dr. Hebert: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101.
Drs. Sisk, Wang, Horowitz, and McLaughlin: Mount Sinai School of Medicine, Department of Health Policy, One Gustave L Levy Plaza Box 1077, New York, NY 10029-6574.
Ms. Tuzzio: Group Health Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.
Ms. Casabianca: Department of Psychology, Fordham University, Dealy Hall, Room 226, 441 East Fordham Road, Bronx, NY 10458.
Dr. Chassin: The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181.
Author Contributions: Conception and design: P.L. Hebert, J.E. Sisk, M.R. Chassin, C. Horowitz, M.A. McLaughlin.
Analysis and interpretation of the data: P.L. Hebert, J.E. Sisk, J.J. Wang, J.M. Casabianca, M.R. Chassin, C. Horowitz, M.A. McLaughlin.
Drafting of the article: P.L. Hebert, J.E. Sisk.
Critical revision of the article for important intellectual content: J.E. Sisk, M.R. Chassin, C. Horowitz, M.A. McLaughlin
Final approval of the article: P.L. Hebert, J.E. Sisk, C. Horowitz, M.A. McLaughlin.
Provision of study materials or patients: L. Tuzzio, C. Horowitz.
Statistical expertise: P.L. Hebert, J.J. Wang, J.M. Casabianca.
Obtaining of funding: J.E. Sisk.
Administrative, technical, or logistic support: L. Tuzzio, J.M. Casabianca, M.R. Chassin.
Collection and assembly of data: J.E. Sisk, J.J. Wang, L. Tuzzio, J.M. Casabianca, M.A. McLaughlin.
Hebert P., Sisk J., Wang J., Tuzzio L., Casabianca J., Chassin M., Horowitz C., McLaughlin M.; 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.
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.
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Cardiology, Healthcare Delivery and Policy, High Value Care, Heart Failure.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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