Turner, D.A., Paul, S., Stone, M.A., Juarez-Garcia, A., Squire, I. and Khunti, K.
Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care
Heart, 92, (12), . (doi:10.1136/hrt.2007.125708).
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Objective: To determine if a disease management
programme for patients with coronary heart disease and
heart failure represents an efficient use of health services
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 (J540), 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 costeffective
service, as additional QALY are generated at an
acceptable extra cost.
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