title: Cost-effectiveness of a nurse facilitated, cognitive behavioural self-management programme compared with usual care using a CBT manual alone for patients with heart failure: secondary analysis of data from the SEMAPHFOR trial.
abstract: OBJECTIVE
  To assess the cost-effectiveness of a nurse facilitated, cognitive behavioural self-management programme for patients with heart failure compared with usual care including the un-facilitated access to the same manual, from the perspective of the NHS.
  
  
  METHODS
  Data were obtained from a pragmatic, multi-centre, randomized controlled 'open' trial conducted in seven centres in the UK between 2006 and 2008. Effectiveness was estimated as Quality-Adjusted Life Years. Resource use was measured prospectively on all patients using information provided by patients in postal questionnaires, case-note review, electronic record review and interviews with patients. Unit costs were obtained from the literature and applied to the relevant resource use to estimate total costs. Multiple imputation was used to handle missing data.
  
  
  RESULTS
  There were no substantial differences in the utility scores between treatment groups in all follow-up assessments, in the use of medication or outpatient visits and both groups report a similar frequency of contact with health care professionals. After controlling for baseline utility and using imputed dataset, treatment was associated with a reduction in QALY of 0.004 and a additional cost of £69.49. The probability that the intervention is cost-effective for thresholds between £20,000 and £30,000 is around 45%.
  
  
  CONCLUSIONS
  There is little evidence that the addition of the intervention had any effect on costs or outcomes. The uncertainty around both estimates of cost and effectiveness mean that it is not reasonable to make recommendations based on cost-effectiveness alone.
authors.affiliation: School of Medicine and Health Economics Group, Universidad de Antioquia, Medellín, Colombia.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Mejía
authors.affiliation: Centre for Health Economics, University of York, York, UK. Electronic address: gerry.richardson@york.ac.uk.
authors.forename: Gerry
authors.initials: G
authors.lastname: Richardson
authors.affiliation: British Heart Foundation Care and Education Research Group, Department of Health Sciences, University of York, York, UK.
authors.forename: Jill
authors.initials: J
authors.lastname: Pattenden
authors.affiliation: York Trials Unit, Department of Health Sciences, University of York, York, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cockayne
authors.affiliation: British Heart Foundation Care and Education Research Group, Department of Health Sciences, University of York, York, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Lewin
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D006333:Heart Failure / Q000451:nursing* / Q000628:therapy*; D006801:Humans; D008297:Male; D008370:Manuals as Topic; D011446:Prospective Studies; D012648:Self Care / Q000379:methods*; D016896:Treatment Outcome
keywords: Cognitive therapy; Cost effectiveness; Heart failure; Programme evaluation; Self-care