Cost analysis and cost-effectiveness of NT-proBNP-guided heart failure specialist care in addition to home-based nurse care.
BACKGROUND
Heart failure management programmes have been shown to reduce re-hospitalizations. We recently investigated a new disease management programme comparing usual care (UC) to home-based nurse care (HNC) and a HNC group in which decision-making was based on NT-proBNP levels (BNC). As re-hospitalization is the main contributing economic factor in heart failure expenditures, we hypothesized that this programme might be able to reduce costs and could be conducted cost effectively compared to UC.


METHODS
One hundred and ninety congestive heart failure patients, who were included in a randomized trial to receive UC, HNC or BNC at discharge, were analysed in a cost-effectiveness model. Different models were applied to perform analysis of all medical costs, and the costs per year survived were chosen as an effectiveness parameter.


RESULTS
Per patient costs because of heart failure treatment in the UC and the BNC group were € 7109 ± 11,687 and € 2991 ± 4885 (P=0·027), respectively. Corrected for death as a competing risk, the costs in the UC group were € 7893 ± 11,734 and were reduced by BNC to €3148 ± 4949 (P=0·012). Considering costs because of all-cause re-hospitalizations, calculated costs per year survived after discharge were € 19,694 ± 26,754 for UC, € 14,262 ± 25 330 for HNC (P > 0·05) and € 8784 ± 14,728 for BNC (t-test-based contrast P=0·015). In all models calculated, HNC was cost neutral.


CONCLUSIONS
NT-BNP-guided heart failure specialist care in addition to home-based nurse care is cost effective and cheaper than standard care, whereas HNC is cost neutral.
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Christopher
C
Adlbrecht
Martin
M
Huelsmann
Rudolf
R
Berger
Deddo
D
Moertl
Guido
G
Strunk
August
A
Oesterle
Roozbeh
R
Ahmadi
Thomas
T
Szucs
Richard
R
Pacher
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003362:Cost-Benefit Analysis; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000451:nursing* / Q000628:therapy; D006699:Home Care Services / Q000191:economics* / Q000592:standards; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D009732:Nursing Care / Q000379:methods; D059039:Standard of Care / Q000191:economics* / Q000592:standards; D013557:Switzerland
D020097:Natriuretic Peptide, Brain