Cost-effectiveness of nurse-led disease management for heart failure in an ethnically diverse urban community

Background: Randomized, controlled trials have shown that nurse-led disease management for patients with heart failure can reduce hospitalizations. Less is known about the cost-effectiveness of these interventions. Objective: To estimate the cost-effectiveness of a nurse-led disease management intervention over 12 months, implemented in a randomized, controlled effectiveness trial. Design: Cost-effectiveness analysis conducted alongside a randomized trial. Data Sources: Medical costs from administrative records, and self-reported quality of life and nonmedical costs from patient surveys. Participants: Patients with systolic dysfunction recruited from ambulatory clinics in Harlem, New York. Time Horizon: 12 months. Perspective: Societal and payer. Intervention: 12-month program that involved 1 face-to-face encounter with a nurse and regular telephone follow-up. Outcome Measures: 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). Results of Base-Case Analysis: Costs and quality of life were higher in the nurse-managed group than the usual care group. The ICERs over 12 months were $17 543 per EuroQol-5D-based quality-adjusted life-year (QALY) and $15 169 per Health Utilities Index Mark 3-based QALY (in 2001 U.S. dollars). Results of Sensitivity Analysis: From a payer perspective, the ICER ranged from $3673 to $4495 per 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 suggest that the intervention was most likely cost-effective for patients with less severe (New York Heart Association classes I to II) heart failure. Limitation: The trial was conducted in an ethnically diverse, innercity neighborhood; thus, results may not be generalizable to other communities. Conclusion: Over 12 months, the nurse-led disease management program was a reasonably cost-effective way to reduce the burden of heart failure in this community.