1. Cost-effectiveness of a nurse-led internet-based vascular risk factor management programme: economic evaluation alongside a randomised controlled clinical trial
- Author
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Y. van der Graaf, Joris W.P. Vernooij, Frank L.J. Visseren, G.A. de Wit, H M H Grandjean, H A H Kaasjager, J Wierdsma, Jacoba P. Greving, and M M C Hovens
- Subjects
Cost effectiveness ,Cost-Benefit Analysis ,Cardiovascular Medicine ,law.invention ,Quality of life ,Randomized controlled trial ,law ,Risk Factors ,Epidemiology ,Medicine ,EPIDEMIOLOGY ,Non-U.S. Gov't ,VASCULAR MEDICINE ,UTILITY ,Medicine(all) ,OUTCOMES ,Research Support, Non-U.S. Gov't ,General Medicine ,Telemedicine ,Multicenter Study ,Models, Economic ,Treatment Outcome ,Randomized Controlled Trial ,HEALTH ,Quality-Adjusted Life Years ,COUNTRIES ,medicine.medical_specialty ,HEALTH ECONOMICS ,Research Support ,Online Systems ,Journal Article ,Humans ,CORONARY-HEART-DISEASE ,Internet ,Health economics ,business.industry ,Vascular disease ,Research ,ADULTS ,CARE ,medicine.disease ,Atherosclerosis ,PREVENTION ,Quality-adjusted life year ,Clinical trial ,Self Care ,Physical therapy ,Quality of Life ,business ,Delivery of Health Care ,Program Evaluation - 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. Design Cost-effectiveness analysis alongside a randomised controlled trial (the Internet-based vascular Risk factor Intervention and Self-management (IRIS) study). Setting Multicentre trial in a secondary and tertiary healthcare setting. Participants 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. Intervention 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. Main outcome measures 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. Trial registration number NCT00785031.
- Published
- 2015