Cost‐effectiveness of a nurse‐led education and psychosocial programme for patients with chronic heart failure and their partners

Abstract

Aims and objectives This randomised controlled trial was conducted to estimate the cost-effectiveness of a nurse-led education and psychosocial support programme for patients with heart failure (HF) and their partners. Background There are few studies evaluating cost-effectiveness of interventions among HF patient–partner dyads. Methods Dyads randomised to the experimental group received nurse-led counselling, computer-based education and written materials aimed at developing problem-solving skills at two, six and 12 weeks after hospitalisation with HF exacerbation. The dyads in the control group received usual care. A cost-effectiveness analysis that included costs associated with staff time to deliver the intervention and travel costs was conducted at 12 months. Quality-adjusted life-year (QALY) weights for patients and partners were estimated by SF-6D. Results A total of 155 dyads were included. The intervention cost was €223 per patient. Participants in both groups showed improvements in QALY weights after 12 months. However, no significant difference in QALY weights was found between the patients in the two groups, nor among their partners. Conclusion The intervention was not proven cost-effective, neither for patients nor for partners. The intervention, however, had trends (but not significant) effects on the patient–partner dyads, and by analysing the QALY gained from the dyad, a reasonable mean cost-effectiveness ratio was achieved. Relevance to clinical practice The study shows trends of a cost-effective education and psychosocial care of HF patient–partner dyads.

A systematic review of heart failure dyadic self-care interventions focusing on intervention components, contexts, and outcomes

“…(Schwarz et al, 2008) In the five papers which reported secondary outcomes or primary outcome variables at a later time null findings were noted. (Agren et al, 2013;Agren et al, 2015;Liljeroos et al, 2015Liljeroos et al, , 2016Liljeroos, Agren, Jaarsma, & Stromberg, 2014a) These included outcomes such as quality adjusted life years, (Agren et al, 2013) carer tasks, burden or patient morbidity, Liljeroos et al, 2016) or non-sustaining differences at a subsequent measurement time. (Liljeroos et al, 2015;Liljeroos et al, 2014a) Deeper analysis identified perceived control, quality of life, preparedness to care, self-care, depression, social support and rehospitalization as the outcome variables with mixed (positive and null) findings (Table 3).…”

Research status and hotspots of economic evaluation in nursing by co-word clustering analysis

“…Cost-benefit analysis supports the more widespread implementation of some education program, 17 and also justify some programs are not cost-effective which should be further developed and modified. 18…”

Setting the Boundaries for Economic Evaluation: Investigating Time Horizon and Family Effects in the Case of Postnatal Depression

“…Although there is not yet consensus on how and when to include family effects in economic evaluations, key decision makers, including those in the United Kingdom and the United States, have taken the position that relevant family effects should be included [23,24]. They have been considered only in limited contexts, including prevention of HIV transmission, using a net monetary benefit approach [25]; chronic heart failure, by summation of patient and carer quality-adjusted life-years (QALYs) [26]; children's vaccinations, taking carer QALYs and productivity losses into account [27][28][29]; and dementia, with patients and carers analyzed separately [30]. The inclusion of family effects might also affect the appropriate time horizon because the impact of children's problems could extend into the child's adulthood [31].…”