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...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2008-12, Vol.94 (12), p.1601-1606 |
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| creator | Turner, D A Paul, S Stone, M A Juarez-Garcia, A Squire, I Khunti, K |
| description | 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. |
| doi_str_mv | 10.1136/hrt.2007.125708 |
| format | Article |
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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.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/hrt.2007.125708</identifier><identifier>PMID: 18450843</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>Aged ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular disease ; Cardiovascular diseases ; Chronic Disease ; Clinical trials ; Clinics ; Cluster Analysis ; Coronary Disease - economics ; Coronary Disease - nursing ; Coronary Disease - prevention & control ; Coronary heart disease ; Cost analysis ; Cost-Benefit Analysis ; Disease Management ; Disease prevention ; Drug Costs ; Economics ; Electrocardiography ; Estimates ; Family medical history ; Family Practice - economics ; Family Practice - statistics & numerical data ; Female ; Health Resources - economics ; Health Resources - utilization ; Health services ; Heart ; Heart attacks ; Heart failure ; Heart Failure - economics ; Heart Failure - nursing ; Heart Failure - prevention & control ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Hospitals ; Humans ; Male ; Medical sciences ; Mortality ; Nurse Clinicians - economics ; Nurse Clinicians - utilization ; Nurses ; Patient admissions ; Primary care ; Quality of Life ; Quality-Adjusted Life Years ; R&D ; Research & development ; Secondary Prevention</subject><ispartof>Heart (British Cardiac Society), 2008-12, Vol.94 (12), p.1601-1606</ispartof><rights>2008 BMJ Publishing Group and British Cardiac Society</rights><rights>2008 INIST-CNRS</rights><rights>Copyright: 2008 2008 BMJ Publishing Group and British Cardiac Society</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b426t-f0a6b7aa5c49d729fd01b19c6dfe49bda6876b5c573771930c6d222dff68cc673</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://heart.bmj.com/content/94/12/1601.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://heart.bmj.com/content/94/12/1601.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77342,77373</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20832996$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18450843$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Turner, D A</creatorcontrib><creatorcontrib>Paul, S</creatorcontrib><creatorcontrib>Stone, M A</creatorcontrib><creatorcontrib>Juarez-Garcia, A</creatorcontrib><creatorcontrib>Squire, I</creatorcontrib><creatorcontrib>Khunti, K</creatorcontrib><title>Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><description>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.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Chronic Disease</subject><subject>Clinical trials</subject><subject>Clinics</subject><subject>Cluster Analysis</subject><subject>Coronary Disease - economics</subject><subject>Coronary Disease - nursing</subject><subject>Coronary Disease - prevention & control</subject><subject>Coronary heart disease</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>Disease Management</subject><subject>Disease prevention</subject><subject>Drug Costs</subject><subject>Economics</subject><subject>Electrocardiography</subject><subject>Estimates</subject><subject>Family medical history</subject><subject>Family Practice - economics</subject><subject>Family Practice - statistics & numerical data</subject><subject>Female</subject><subject>Health Resources - economics</subject><subject>Health Resources - utilization</subject><subject>Health services</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Heart Failure - economics</subject><subject>Heart Failure - nursing</subject><subject>Heart Failure - prevention & control</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Nurse Clinicians - economics</subject><subject>Nurse Clinicians - utilization</subject><subject>Nurses</subject><subject>Patient admissions</subject><subject>Primary care</subject><subject>Quality of Life</subject><subject>Quality-Adjusted Life Years</subject><subject>R&D</subject><subject>Research & development</subject><subject>Secondary Prevention</subject><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkV-L1TAQxYso7rr67JsURB-E3k3SNmke9eI_uCiKyr6FaTrZzbVNNElFP4Lf2pSWK_gieZgw8zuHGU5RPKRkR2nNL29C2jFCxI6yVpDuVnFOG95VjNCr2_lft23FSS3OinsxHgkhjez43eKMdk1LuqY-L37vfUwVGoM62R_oMMbSmxLKwUaEiOUEDq5xQpfKb8FfB5gmLI0PZUTt3QDhV-5jVibr3SLVPni3tG8QQjr5gBu2jgE7zgFL67LSTguqIeD94o6BMeKDrV4Un1-9_LR_Ux3ev367f36o-obxVBkCvBcArW7kIJg0A6E9lZoPBhvZD8A7wftWt6IWgsqa5AljbDCGd1pzUV8UT1fffM73GWNSk40axxEc-jkqLkV-Dc3g43_Ao5-Dy7spKjrCZSPbhbpcKR18jAGN2o5SlKglI5UzUktGas0oKx5tvnM_4fCX30LJwJMNgKhhNAGctvHEsezBpOSZq1bOxoQ_T3MIX1W-U7Tq3Ze9uiIf6o8H9kItvs9Wvp-O_93yD4QKuJc</recordid><startdate>20081201</startdate><enddate>20081201</enddate><creator>Turner, D A</creator><creator>Paul, S</creator><creator>Stone, M A</creator><creator>Juarez-Garcia, A</creator><creator>Squire, I</creator><creator>Khunti, K</creator><general>BMJ Publishing Group Ltd and British Cardiovascular Society</general><general>BMJ</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20081201</creationdate><title>Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care</title><author>Turner, D A ; Paul, S ; Stone, M A ; Juarez-Garcia, A ; Squire, I ; Khunti, K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b426t-f0a6b7aa5c49d729fd01b19c6dfe49bda6876b5c573771930c6d222dff68cc673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Chronic Disease</topic><topic>Clinical trials</topic><topic>Clinics</topic><topic>Cluster Analysis</topic><topic>Coronary Disease - economics</topic><topic>Coronary Disease - nursing</topic><topic>Coronary Disease - prevention & control</topic><topic>Coronary heart disease</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>Disease Management</topic><topic>Disease prevention</topic><topic>Drug Costs</topic><topic>Economics</topic><topic>Electrocardiography</topic><topic>Estimates</topic><topic>Family medical history</topic><topic>Family Practice - economics</topic><topic>Family Practice - statistics & numerical data</topic><topic>Female</topic><topic>Health Resources - economics</topic><topic>Health Resources - utilization</topic><topic>Health services</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Heart Failure - economics</topic><topic>Heart Failure - nursing</topic><topic>Heart Failure - prevention & control</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Nurse Clinicians - economics</topic><topic>Nurse Clinicians - utilization</topic><topic>Nurses</topic><topic>Patient admissions</topic><topic>Primary care</topic><topic>Quality of Life</topic><topic>Quality-Adjusted Life Years</topic><topic>R&D</topic><topic>Research & development</topic><topic>Secondary Prevention</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Turner, D A</creatorcontrib><creatorcontrib>Paul, S</creatorcontrib><creatorcontrib>Stone, M A</creatorcontrib><creatorcontrib>Juarez-Garcia, A</creatorcontrib><creatorcontrib>Squire, I</creatorcontrib><creatorcontrib>Khunti, K</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Turner, D A</au><au>Paul, S</au><au>Stone, M A</au><au>Juarez-Garcia, A</au><au>Squire, I</au><au>Khunti, K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care</atitle><jtitle>Heart (British Cardiac Society)</jtitle><addtitle>Heart</addtitle><date>2008-12-01</date><risdate>2008</risdate><volume>94</volume><issue>12</issue><spage>1601</spage><epage>1606</epage><pages>1601-1606</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>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.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>18450843</pmid><doi>10.1136/hrt.2007.125708</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged Biological and medical sciences Cardiology. Vascular system Cardiovascular disease Cardiovascular diseases Chronic Disease Clinical trials Clinics Cluster Analysis Coronary Disease - economics Coronary Disease - nursing Coronary Disease - prevention & control Coronary heart disease Cost analysis Cost-Benefit Analysis Disease Management Disease prevention Drug Costs Economics Electrocardiography Estimates Family medical history Family Practice - economics Family Practice - statistics & numerical data Female Health Resources - economics Health Resources - utilization Health services Heart Heart attacks Heart failure Heart Failure - economics Heart Failure - nursing Heart Failure - prevention & control Heart failure, cardiogenic pulmonary edema, cardiac enlargement Hospitals Humans Male Medical sciences Mortality Nurse Clinicians - economics Nurse Clinicians - utilization Nurses Patient admissions Primary care Quality of Life Quality-Adjusted Life Years R&D Research & development Secondary Prevention |
| title | Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care |
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