ORIGINAL ARTICLES

Epidemiology

Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care

D A Turner¹, S Paul², M A Stone³, A Juarez-Garcia⁴, I Squire⁵, K Khunti³

¹ Wessex Institute for Health Research and Development, University of Southampton, Southampton, UK
² Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
³ Division of General Practice & PHC, Department of Health Sciences, University of Leicester, Leicester, UK
⁴ Health Services Management Centre, University of Birmingham, UK
⁵ Department of Cardiovascular Sciences, University of Leicester, Leicester, UK

David Turner, Wessex Institute for Health Research and Development, Mail point 728, Boldrewood, University of Southampton, Southampton SO16 7PX, UK; dturner{at}soton.ac.uk

Objective: To determine if a disease management programme for patients with coronary heart disease and heart failure represents an efficient use of health services resources.

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 (540), 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 cost-effective service, as additional QALY are generated at an acceptable extra cost.

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