Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care

Objective:To determine if a disease management programme for patients with coronary heart disease and heart failure represents an efficient use of health services resources.Methods:We carried out an economic evaluation alongside a cluster randomised control trial of 1163 patients with coronary heart disease and chronic heart failure in 20 primary care practices in the United Kingdom. Practices were randomised to either a control group, where patients received standard general practice care, or an intervention group where patients had access to a specialist nurse-led disease management programme. We estimated costs in both groups for coronary heart disease-related resource use. The main outcome measure used in the economic evaluation was quality adjusted life years (QALY) measured using the EuroQol.Results:The disease management programme was associated with an increase in the QALY measured of 0.03 per year and an increase in the total NHS costs of £425 (€540), of this only £83 was directly associated with the provision of the nurse clinics. The clinics generated additional QALY at an incremental cost of £13 158 per QALY compared to the control group.Conclusions:The use of a nurse-led disease management programme is associated with increased costs in other coronary heart disease-related services as well as for the costs of the clinics. They are also associated with improvements in health. Even in the short term these disease management programmes may represent a cost-effective service, as additional QALY are generated at an acceptable extra cost.