title: Cost-effectiveness of a nurse-led internet-based vascular risk factor management programme: economic evaluation alongside a randomised controlled clinical trial.
abstract: OBJECTIVE
  To assess the cost-effectiveness of an internet-based, nurse-led vascular risk factor management programme in addition to usual care compared with usual care alone in patients with a clinical manifestation of a vascular disease.
  
  
  METHODS
  Cost-effectiveness analysis alongside a randomised controlled trial (the Internet-based vascular Risk factor Intervention and Self-management (IRIS) study).
  
  
  METHODS
  Multicentre trial in a secondary and tertiary healthcare setting.
  
  
  METHODS
  330 patients with a recent clinical manifestation of atherosclerosis in the coronary, cerebral, or peripheral arteries and with ≥2 treatable vascular risk factors not at goal.
  
  
  METHODS
  The intervention consisted of a personalised website with an overview and actual status of patients' vascular risk factors, and mail communication with a nurse practitioner via the website for 12 months. The intervention combined self-management support, monitoring of disease control and pharmacotherapy.
  
  
  METHODS
  Societal costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness.
  
  
  RESULTS
  Patients experienced equal health benefits, that is, 0.86 vs 0.85 QALY (intervention vs usual care) at 1 year. Adjusting for baseline differences, the incremental QALY difference was -0.014 (95% CI -0.034 to 0.007). The intervention was associated with lower total costs (€4859 vs €5078, difference €219, 95% CI -€2301 to €1825). The probability that the intervention is cost-effective at a threshold value of €20,000/QALY, is 65%. At mean annual cost of €220 per patient, the intervention is relatively cheap.
  
  
  CONCLUSIONS
  An internet-based, nurse-led intervention in addition to usual care to improve vascular risk factors in patients with a clinical manifestation of a vascular disease does not result in a QALY gain at 1 year, but has a small effect on vascular risk factors and is associated with lower costs.
  
  
  BACKGROUND
  NCT00785031.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Greving
authors.affiliation: Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: H A H
authors.initials: HA
authors.lastname: Kaasjager
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J W P
authors.initials: JW
authors.lastname: Vernooij
authors.affiliation: Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: M M C
authors.initials: MM
authors.lastname: Hovens
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Wierdsma
authors.affiliation: Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: H M H
authors.initials: HM
authors.lastname: Grandjean
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: G A
authors.initials: GA
authors.lastname: de Wit
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: F L J
authors.initials: FL
authors.lastname: Visseren
mesh_terms: D050197:Atherosclerosis / Q000451:nursing* / Q000628:therapy; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D006801:Humans; D020407:Internet; D018803:Models, Economic; D009862:Online Systems / Q000458:organization & administration*; D015397:Program Evaluation; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012648:Self Care; D017216:Telemedicine / Q000458:organization & administration; D016896:Treatment Outcome
keywords: EPIDEMIOLOGY; HEALTH ECONOMICS; VASCULAR MEDICINE