AIM: Nurse-led program is cost-effective way to reduce heart failure
In one year, a nurse-led disease management program was a reasonably cost-effective way to reduce the burden of heart failure for a community, according to a study in the Oct. 21 issue of the Annals of the Internal Medicine.

Randomized, controlled trials have shown that nurse-led disease management for patients with heart failure can reduce hospitalizations. However, the researchers noted that less is known about the cost-effectiveness of the interventions.

Paul L. Hebert, PhD, from Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues evaluated the medical costs from administrative records, self-reported quality of life and nonmedical costs from patient surveys. They assessed the 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).

The researchers found that costs and quality of life were higher in the nurse-managed group than the usual care group. The ICER over 12 months was $17,543 per EuroQol-5D and $15,169 per Health Utilities Index Mark 3 (in 2001 U.S. dollars).

From a payor perspective, the investigators said that the ICER ranged from $3,673 to $4,495 per quality-adjusted life-year (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 suggested that the intervention was most likely cost-effective for patients with less severe (N.Y. Heart Association classes I to II) heart failure.

However, the authors cautioned that the results might not apply to patients in less socioeconomically disadvantaged settings.