title: Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: follow up of a randomised controlled trial.
abstract: OBJECTIVE
  To establish the cost effectiveness of nurse led secondary prevention clinics for coronary heart disease based on four years' follow up of a randomised controlled trial.
  
  
  METHODS
  Cost effectiveness analysis.
  
  
  METHODS
  19 general practices in north east Scotland.
  
  
  METHODS
  1343 patients (673 in intervention group and 670 in control group, as originally randomised) aged under 80 years with a diagnosis of coronary heart disease but without terminal illness or dementia and not housebound.
  
  
  METHODS
  Nurse led clinics to promote medical and lifestyle components of secondary prevention.
  
  
  METHODS
  Costs of clinics; overall costs to health service; and cost per life year and per quality adjusted life year (QALY) gained, expressed as incremental gain in intervention group compared with control group.
  
  
  RESULTS
  The cost of the intervention (clinics and drugs) was 136 pounds sterling (254 dollars; 195 euros) per patient higher (1998-9 prices) in the intervention group, but the difference in other NHS costs, although lower for the intervention group, was not statistically significant. Overall, 28 fewer deaths occurred in the intervention group leading to a gain in mean life years per patient of 0.110 and of 0.124 QALYs. The incremental cost per life year saved was 1236 pounds sterling and that per QALY was 1097 pounds sterling.
  
  
  CONCLUSIONS
  Nurse led clinics for the secondary prevention of coronary heart disease in primary care seem to be cost effective compared with most interventions in health care, with the main gains in life years saved.
authors.affiliation: Health Economics Facility, Health Services Management Centre, University of Birmingham, Birmingham B15 2RT. j.p.raftery@bham.ac.uk
authors.forename: James P
authors.initials: JP
authors.lastname: Raftery
authors.forename: Guiqing L
authors.initials: GL
authors.lastname: Yao
authors.forename: Peter
authors.initials: P
authors.lastname: Murchie
authors.forename: Neil C
authors.initials: NC
authors.lastname: Campbell
authors.forename: Lewis D
authors.initials: LD
authors.lastname: Ritchie
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000191:economics / Q000451:nursing* / Q000517:prevention & control; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000191:economics*; D005500:Follow-Up Studies; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012606:Scotland
references.citation: BMJ. 2001 Jun 2;322(7298):1338
references.pmid: 11387182
references.citation: BMJ. 1996 May 18;312(7041):1274-8
references.pmid: 8634618
references.citation: BMJ. 2003 Jan 11;326(7380):84
references.pmid: 12521974
references.citation: BMJ. 1996 May 18;312(7041):1265-8
references.pmid: 8634616
references.citation: J Health Econ. 2002 Mar;21(2):271-92
references.pmid: 11939242
references.citation: J Epidemiol Community Health. 1996 Oct;50(5):538-40
references.pmid: 8944861
references.citation: BMJ. 1998 May 9;316(7142):1434-7
references.pmid: 9572758
references.citation: BMJ. 2001 Dec 1;323(7324):1300-3
references.pmid: 11731399
references.citation: Evid Based Nurs. 2003 Oct;6(4):123
references.pmid: 14577406
references.citation: BMJ. 1996 May 18;312(7041):1269-73
references.pmid: 8634617
references.citation: BMJ. 2001 Oct 27;323(7319):957-62
references.pmid: 11679383
references.citation: Heart. 1998 Nov;80(5):447-52
references.pmid: 9930042
references.citation: Health Econ. 1997 May-Jun;6(3):243-52
references.pmid: 9226142