title: [Cost-effectiveness of study nurses in the management of patients with heart failure. A systematic review].
abstract: OBJECTIVE
  Heart failure is currently one of the most common and cost-intensive diseases. Furthermore, high morbidity and mortality are distinctive for this disease. Therefore, new treatment programs are increasingly developed; especially the care of heart failure patients by specialized nurses (study nurses) represents a frequent new concept. This review gives a systematic overview of the cost-effectiveness of new treatment concepts with study nurses in comparison to the conventional care of heart failure.
  
  
  METHODS
  A systematic literature search in MEDLINE was performed for the period from 1995 till April 2008. The search strategy included terms from three essential areas relating to the working subject: twelve search keys with regard to the clinical picture, 21 words concerning the intervention with study nurses, and 27 terms with reference to health economics. The literature selection was carried out on the basis of a priori defined in- and exclusion criteria. Economic evaluations based on randomized controlled trials with a study duration of at least 6 months which were published in English or German were enclosed. An extraction of the relevant data as well as a qualitative synthesis of information were conducted.
  
  
  RESULTS
  A total of 13 studies were identified. With five of nine of the enclosed publications, a statistically significant reduction of the number of all-cause rehospitalizations was reported. Two of twelve publications showed a statistically significant decrease in mortality in favor of the intervention group. Twelve of 13 publications only reported the costs and effects of both groups separately. For the five of nine publications with significant reductions of rehospitalization, an own calculation of the incremental cost-effectiveness ratio (ICER) could be carried out based on the cost and effect data. It turned out an ICER of costs at the rate of 490 Euros up to savings of 7,330 Euros per prevented rehospitalization.
  
  
  CONCLUSIONS
  This systematic review shows an international trend that concepts for the care of patients with heart failure that involve study nurses are cost-effective. For the German context there are no comparable data available.
authors.affiliation: Alfried Krupp von Bohlen und Halbach-Stiftungslehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Campus Essen. Janine.Biermann@medman.uni-due.de
authors.forename: J
authors.initials: J
authors.lastname: Biermann
authors.forename: S
authors.initials: S
authors.lastname: Mostardt
authors.forename: T
authors.initials: T
authors.lastname: Neumann
authors.forename: R
authors.initials: R
authors.lastname: Erbel
authors.forename: J
authors.initials: J
authors.lastname: Wasem
authors.forename: A
authors.initials: A
authors.lastname: Neumann
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D004471:Economics, Nursing / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics* / Q000401:mortality / Q000451:nursing*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D009726:Nurses / Q000706:statistics & numerical data*