Nurse-led disease management of heart failure is cost-effective in ethnically diverse urban communities
Research Activities, June 2009, No. 346
Nurse-led disease management programs not only improve quality of life for heart failure patients, but are also reasonably cost effective. That's the finding from a recent study, which looked at this intervention over a period of 12 months.
In their investigation, researchers randomized 406 patients with heart failure to participate in either a nurse-led disease management program or receive usual care. All were from the Harlem neighborhood in New York City and the majority were black and Hispanic, of lower socioeconomic status. During the 12 months, patients in the program met with a nurse, who then followed up with regular telephone calls. The nurses helped patients follow a low-salt diet and stressed the importance of taking medications. Every 3 months, trained surveyors called patients in both groups to ask about physical functioning and care received. Administrative records were also analyzed to determine medical costs and their cost effectiveness.
Compared with patients in the usual care group, nurse-led patients maintained better physical functioning over the 12-month period of the study. They also had greater quality-of-life scores during every 3-month interval. The nurse-led intervention cost $2,177 for each patient. This was offset, however, by the $2,378 savings realized in lower hospitalization costs per person. The researchers calculated that the improved quality of life cost society less than $25,000 per quality-adjusted-life-year. This is considered a reasonable cost to gain 1 year of healthy life. In this study, the nurse-led intervention was most cost effective for patients with earlier stages of heart failure (New York Heart Association class I and II).
Since the study enrolled patients from an ethnically diverse, inner-city neighborhood, the results may not apply to other geographic settings. More research is needed to determine the best types of nurse-led management interventions and which heart failure patients will benefit the most from them. The study was supported by the Agency for Healthcare Research and Quality (HS10402).
See "Cost-effectiveness of nurse-led disease management for heart failure in an ethnically-diverse urban community," by Paul L. Hebert, Ph.D., Jane E. Sisk, Ph.D., Jason J. Wang, Ph.D., and others, in the October 2008 Annals of Internal Medicine 149, pp. 540-548.