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- Title
Cost-Effectiveness of Nurse-Led Disease Management for Heart Failure in an Ethnically Diverse Urban Community.
- Authors
Hebert, Paul L.; Sisk, Jane E.; Wang, Jason J.; Tuzzio, Leah; Casabianca, Jodi M.; Chassin, Mark R.; Horowitz, Carol; McLaughlin, Mary Ann
- Abstract
Background: Randomized, controlled trials have shown that nurseled disease management for patients with heart failure can reduce hospitalizations. Less is known about the cost-effectiveness of these interventions. Objective: To estimate the cost-effectiveness of a nurse-led disease management intervention over 12 months, implemented in a randomized, controlled effectiveness trial. Design: Cost-effectiveness analysis conducted alongside a randomized trial. Data Sources: Medical costs from administrative records, and self-reported quality of life and nonmedical costs from patient surveys. Participants: Patients with systolic dysfunction recruited from ambulatory clinics in Harlem, New York. Time Horizon: 12 months. Perspective: Societal and payer. Intervention: 12-month program that involved 1 face-to-face encounter with a nurse and regular telephone follow-up. Outcome Measures: 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). Results of Base-Case Analysis: Costs and quality of life were higher in the nurse-managed group than the usual care group. The ICERs over 12 months were $17 543 per EuroQol-5D-based quality-adjusted life-year (QALY) and $15 169 per Health Utilities Index Mark 3-based QALY (in 2001 U.S. dollars). Results of Sensitivity Analysis: 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 $13 460 to $15 556 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. Limitation: The trial was conducted in an ethnically diverse, inner-city neighborhood; thus, results may not be generalizable to other communities. Conclusion: 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.
- Subjects
HEART failure; MEDICAL care cost control; DISEASE management; COST effectiveness; RANDOMIZED controlled trials; HEALTH services administration
- Publication
Annals of Internal Medicine, 2008, Vol 149, Issue 8, p540
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/0003-4819-149-8-200810210-00006