Economic evaluation of a nurse-led home and clinic-based secondary prevention programme to prevent progressive cardiac dysfunction in high-risk individuals: the nurse-led intervention for less chronic heart failure (nil-chf) randomized controlled study
Journal article
Maru, Shoku, Byrnes, Joshua, Carrington, Melinda, Chan, Kai, Stewart, Simon and Scuffham, Paul. (2018). Economic evaluation of a nurse-led home and clinic-based secondary prevention programme to prevent progressive cardiac dysfunction in high-risk individuals: the nurse-led intervention for less chronic heart failure (nil-chf) randomized controlled study. European Journal of Cardiovascular Nursing. 17(5), pp. 439 - 445. https://doi.org/10.1177/1474515117743979
Authors | Maru, Shoku, Byrnes, Joshua, Carrington, Melinda, Chan, Kai, Stewart, Simon and Scuffham, Paul |
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Abstract | Objective: The objective of this study was to assess the cost-effectiveness of a long-term, nurse-led, multidisciplinary programme of home/clinic visits in preventing progressive cardiac dysfunction in patients at risk of developing de novo chronic heart failure (CHF). Methods: A trial-based analysis was conducted alongside a pragmatic, single-centre, open-label, randomized controlled trial of 611 patients (mean age: 66 years) with subclinical cardiovascular diseases (without CHF) discharged to home from an Australian tertiary referral hospital. A nurse-led home and clinic-based programme (NIL-CHF intervention, n = 301) was compared with standard care (n=310) in terms of life-years, quality-adjusted life-years (QALYs) and healthcare costs. The uncertainty around the incremental cost and QALYs was quantified by bootstrap simulations and displayed on a cost-effectiveness plane. Results: During a median follow-up of 4.2 years, there were no significant between-group differences in life-years (– 0.056, p=0.488) and QALYs (–0.072, p=0.399), which were lower in the NIL-CHF group. The NIL-CHF group had slightly lower all-cause hospitalization costs (AUD$2943 per person; p=0.219), cardiovascular-related hospitalization costs (AUD$1142; p=0.592) and a more pronounced reduction in emergency/unplanned hospitalization costs (AUD$4194 per person; p=0.024). When the cost of intervention was added to all-cause, cardiovascular and emergency-related readmissions, the reductions in the NIL-CHF group were AUD$2742 (p=0.313), AUD$941 (p=0.719) and AUD$3993 (p=0.046), respectively. At a willingness-to-pay threshold of AUD$50,000/QALY, the probability of the NIL-CHF intervention being better-valued was 19%. Conclusions: Compared with standard care, the NIL-CHF intervention was not a cost-effective strategy as life-years and QALYs were slightly lower in the NIL-CHF group. However, it was associated with modest reductions in emergency/ unplanned readmission costs. |
Year | 2018 |
Journal | European Journal of Cardiovascular Nursing |
Journal citation | 17 (5), pp. 439 - 445 |
Publisher | Sage Publications Ltd. |
ISSN | 1474-5151 |
Digital Object Identifier (DOI) | https://doi.org/10.1177/1474515117743979 |
Scopus EID | 2-s2.0-85041578073 |
Page range | 439 - 445 |
Research Group | Mary MacKillop Institute for Health Research |
Publisher's version | File Access Level Controlled |
Place of publication | United States |
Editors | T. Jaarsma |
https://acuresearchbank.acu.edu.au/item/874yq/economic-evaluation-of-a-nurse-led-home-and-clinic-based-secondary-prevention-programme-to-prevent-progressive-cardiac-dysfunction-in-high-risk-individuals-the-nurse-led-intervention-for-less-chronic
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