• Paul L Hebert, Jane E Sisk, Jason J Wang, Leah Tuzzio, Jodi M Casabianca, Mark R Chassin, Carol Horowitz, and Mary Ann McLaughlin.
• Health Services Research and Development, Veterans Affairs Puget Sound Health CareSystem, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA.
• Ann. Intern. Med. 2008 Oct 21; 149 (8): 540-8.

BackgroundRandomized, 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.ObjectiveTo estimate the cost-effectiveness of a nurse-led disease management intervention over 12 months, implemented in a randomized, controlled effectiveness trial.DesignCost-effectiveness analysis conducted alongside a randomized trial.Data SourcesMedical costs from administrative records, and self-reported quality of life and nonmedical costs from patient surveys.ParticipantsPatients with systolic dysfunction recruited from ambulatory clinics in Harlem, New York.Time Horizon12 months.PerspectiveSocietal and payer.Intervention12-month program that involved 1 face-to-face encounter with a nurse and regular telephone follow-up.Outcome MeasuresQuality 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 AnalysisCosts 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 AnalysisFrom 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.LimitationThe trial was conducted in an ethnically diverse, inner-city neighborhood; thus, results may not be generalizable to other communities.ConclusionOver 12 months, the nurse-led disease management program was a reasonably cost-effective way to reduce the burden of heart failure in this community.

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