title: The 3-Year Cost-Effectiveness of a Nurse-Based Case Management versus Usual Care for Elderly Patients with Myocardial Infarction: Results from the KORINNA Follow-Up Study.
abstract: OBJECTIVE
  To assess the 3-year cost-effectiveness of a nurse-based case management intervention in elderly patients with myocardial infarction from a societal perspective.
  
  
  METHODS
  The intervention consisted of one home visit and quarterly telephone calls in the first year, and semi-annual calls in the following 2 years. The primary effect measures were quality-adjusted life-years (QALYs), on the basis of the EuroQol five-dimensional questionnaire (EQ-5D-3L) and adjusted life-years from patients' self-rated health states according to the visual analogue scale (VAS-ALs). A linear regression model was used for adjusted life-years and a gamma model for costs. Estimation uncertainty was addressed by cost-effectiveness acceptability curves, which indicate the likelihood of cost-effectiveness for a given value of willingness to pay. The secondary objective was to examine EQ-5D-3L utility scores and VAS scores among survivors using linear mixed models.
  
  
  RESULTS
  Primary outcomes regarding QALY gains (+0.0295; P = 0.76) and VAS-AL gains (+0.1332; P = 0.09) in the intervention group were not significant. The overall cost difference was -€2575 (P = 0.30). The probability of cost-effectiveness of the case management at a willingness-to-pay value of €0 per QALY was 84% in the case of QALYs and 81% in the case of VAS-ALs. Secondary outcomes concerning survivors' quality of life were significantly better in the intervention group (EQ-5D-3L utilities: +0.104, P = 0.005; VAS: +8.15, P = 0.001) after 3 years.
  
  
  CONCLUSIONS
  The case management was cost-neutral and led to an important and significant improvement in health status among survivors. It was associated with higher QALYs and lower costs but the differences in costs and QALYs were not statistically significant.
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany. Electronic address: hildegard.seidl@helmholtz-muenchen.de.
authors.forename: Hildegard
authors.initials: H
authors.lastname: Seidl
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hunger
authors.affiliation: KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.affiliation: KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany.
authors.forename: Inge
authors.initials: I
authors.lastname: Kirchberger
authors.affiliation: Department for Internal Medicine/Cardiology, Donau-Ries-Kliniken, Nördlingen, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kuch
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Leidl
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D008297:Male; D009203:Myocardial Infarction / Q000191:economics* / Q000628:therapy*; D009726:Nurses / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D064232:Visual Analog Scale
keywords: case management; cost-effectiveness analysis; myocardial infarction; quality-adjusted life-years