title: Cost-effectiveness of cardiovascular risk management by practice nurses in primary care.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. The randomised controlled SPRING-trial (SPRING-RCT) shows that cardiovascular risk management by practice nurses in general practice with and without self-monitoring both decreases cardiovascular risk, with no additional effect of self-monitoring. For considering future approaches of cardiovascular risk reduction, cost effectiveness analyses of regular care and additional self-monitoring are performed from a societal perspective on data from the SPRING-RCT.
  
  
  METHODS
  Direct medical and productivity costs are analysed alongside the SPRING-RCT, studying 179 participants (men aged 50-75 years, women aged 55-75 years), with an elevated cardiovascular risk, in 20 general practices in the Netherlands. Standard cardiovascular treatment according to Dutch guidelines is compared with additional counselling based on self-monitoring at home (pedometer, weighing scale and/ or blood pressure device) both by trained practice nurses. Cost-effectiveness is evaluated for both treatment groups and patient categories (age, sex, education).
  
  
  RESULTS
  Costs are €98 and €187 per percentage decrease in 10-year cardiovascular mortality estimation, for the control and intervention group respectively. In both groups lost productivity causes the majority of the costs. The incremental cost-effectiveness ratio is approximately €1100 (95% CI: -5157 to 6150). Self-monitoring may be cost effective for females and higher educated participants, however confidence intervals are wide.
  
  
  CONCLUSIONS
  In this study population, regular treatment is more cost effective than counselling based on self-monitoring, with the majority of costs caused by lost productivity.
  
  
  BACKGROUND
  Trialregister.nl identifier: http://NTR2188.
authors: University Medical Center Groningen, Department General Practice, University of Groningen, Groningen, The Netherlands. a.h.tiessen@umcg.nl
authors: Ans H
authors: AH
authors: Tiessen
authors: Karin M
authors: KM
authors: Vermeulen
authors: Jan
authors: J
authors: Broer
authors: Andries J
authors: AJ
authors: Smit
authors: Klaas
authors: K
authors: van der Meer
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics* / Q000451:nursing*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D004522:Educational Status; D004526:Efficiency; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D059017:Primary Care Nursing / Q000191:economics*; D012308:Risk Management / Q000191:economics*; D012648:Self Care / Q000191:economics