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

Abstract

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.

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

“…Whether a DMP is a cost-effective way to manage these patients is not well established. The studies suggest a DMP may be cost effective or the extra cost associated with a DMP is acceptable (131,(139)(140)(141)(142). In a recent analysis by Whellan et al (143), an interesting concept based on the American system of reimbursement is presented.…”

Relative cost effectiveness of the SPHERE intervention in selected patient subgroups with existing coronary heart disease

“…They add further weight to the assertion that disease management programmes delivered in primary care may be a cost effective alternative to existing care for patients with existing coronary heart disease [31][32][33]. The gains associated with the intervention were predominantly driven by reductions in costs rather than improvements in effectiveness.…”

The 3-Year Cost-Effectiveness of a Nurse-Based Case Management versus Usual Care for Elderly Patients with Myocardial Infarction: Results from the KORINNA Follow-Up Study

“…Several nurse-led intervention programs focused on patients younger than 65 years or were tailored to patients with heart failure so that the generalization to higher age groups or to patients discharged after an acute cardiac event cannot be ensured. For patients with CHD, there is only one study on cost-effectiveness with a follow-up period of 4 years [14] and two studies covering a period of 1 year [15,16]. In the 4-year follow-up study, Raftery et al [14] observed no differences in costs but differences in QALYs (þ0.124 QALYs; ICER €1590/QALY).…”

“…There are only three studies that performed a formal cost-effectiveness analysis for patients with CHD [14][15][16] and five studies that performed an analysis for patients with heart failure [17][18][19][20][21] estimating cost per QALY with different results.…”