Specialist nurse-led clinics to improve control of hypertension and hyperlipidemia in diabetes: economic analysis of the SPLINT trial.
OBJECTIVE
To determine the cost-effectiveness of specialist nurse-led clinics provided to improve lipid and blood pressure control in diabetic patients receiving hospital-based care.


METHODS
A policy of targeting improved care through specialist nurse-led clinics is evaluated using a novel method, linking the cost-effectiveness of antihypertensive and lipid-lowering treatments with the cost and level of behavioral change achieved by the specialist nurse-led clinics. Treatment cost-effectiveness is modeled from the U.K. Prospective Diabetes Study and Heart Protection Study treatment trials, whereas specialist nurse-led clinics are evaluated using the Specialist Nurse-Led Clinics to Improve Control of Hypertension and Hyperlipidemia in Diabetes (SPLINT) trial.


RESULTS
Good lipid and blood pressure control are cost-effective treatment goals for patients with diabetes. Modeling findings from treatment trials, blood pressure lowering is estimated to be cost saving and life prolonging (-1,400 dollars/quality-adjusted life-year [QALY]), whereas lipid-lowering is estimated to be highly cost-effective (8,230 dollars/QALY). Investing in nurse-led clinics to help achieve these benefits imposes an addition on treatment cost-effectiveness leading to higher estimates: 4,020 dollars/QALY and 19,950 dollars/QALY, respectively. For both clinics combined, the estimated cost-effectiveness is 9,070 dollars/QALY. Using an acceptability threshold of 50,000 dollars/QALY, the likelihood that blood pressure-lowering clinics are cost-effective is 77%, lipid clinics 99%, and combined clinics 83%.


CONCLUSIONS
A method is described for evaluating the cost-effectiveness of policies to change patient uptake of health care. Such policies are less attractive than treatment cost-effectiveness (which implies cost-less self-implementation). However, specialist nurse-led clinics, as an adjunct to hospital-based diabetic care, combining both lipid and blood pressure control, appear effective and likely to provide excellent value for money.
Mason
James M
JM
School for Health, University of Durham, Stockton-on-Tees, UK. j.m.mason@durham.ac.uk
Freemantle
Nick
N
Gibson
J Martin
JM
New
John P
JP
D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000451:nursing* / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000191:economics / Q000451:nursing* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000191:economics / Q000451:nursing* / Q000517:prevention & control; D004739:England; D006291:Health Policy; D006801:Humans; D006949:Hyperlipidemias / Q000517:prevention & control*; D006973:Hypertension / Q000517:prevention & control*; D013041:Specialties, Nursing
D001786:Blood Glucose