title: An economic evaluation of a self-care intervention in persons with heart failure and diabetes.
abstract: BACKGROUND
  Persons with concomitant heart failure (HF) and diabetes mellitus constitute a growing population whose quality of life is encumbered with worse clinical outcomes as well as high health resource use (HRU) and costs.
  
  
  RESULTS
  Extensive data on HRU and costs were collected as part of a prospective cost-effectiveness analysis of a self-care intervention to improve outcomes in persons with both HF and diabetes. HRU costs were assigned from a Medicare reimbursement perspective. Patients (n = 134) randomized to the self-care intervention and those receiving usual care/attention control were followed for 6 months, revealing significant differences in the number of hospitalization days and associated costs between groups. The mean number of inpatient days was 3 with bootstrapped bias-corrected (BCa) confidence intervals (CIs) of 1.8-4.4 d for the intervention group and 7.3 d (BCa CI 4.1-10.9 d) in the control group: P = .044. Total direct HRU costs per participant were an estimated $9,065 (BCa CI $6,496-$11,936) in the intervention and $16,712 (BCa CI 8,200-$26,621) in the control group, for a mean difference of -$7,647 (BCa CI -$17,588 to $809; P = .21) in favor of the intervention, including intervention costs estimated to be $130.67 per patient.
  
  
  CONCLUSIONS
  The self-care intervention demonstrated dominance in lowering costs without sacrificing quality-adjusted life-years.
authors.affiliation: Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia. Electronic address: cmill02@emory.edu.
authors.forename: Carolyn Miller
authors.initials: CM
authors.lastname: Reilly
authors.affiliation: Emory University, School of Medicine and School of Nursing, Atlanta, Georgia; Stony Brook University, Stony Brook, New York.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Emory University, Rollins School of Public Health and School of Nursing, Atlanta, Georgia.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Culler
authors.affiliation: Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Gary
authors.affiliation: Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
authors.forename: Melinda
authors.initials: M
authors.lastname: Higgins
authors.affiliation: Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
authors.forename: Peter
authors.initials: P
authors.lastname: Schindler
authors.affiliation: Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
authors.forename: Brittany
authors.initials: B
authors.lastname: Butts
authors.affiliation: Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Dunbar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D005102:Health Expenditures; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012648:Self Care / Q000191:economics*; D014481:United States; D055815:Young Adult
keywords: Diabetes; cost-effectiveness analyses; self-care intervention