Cost-effectiveness of cardiovascular risk management by practice nurses in primary care

Ans H Tiessen,Karin M Vermeulen,Andries J Smit,Klaas Van Der Meer,Jan Broer

doi:10.1186/1471-2458-13-148

Abstract

BackgroundCardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. The randomised controlled SPRING-trial (SPRING-RCT) shows that cardiovascular risk management by practice nurses in general practice with and without self-monitoring both decreases cardiovascular risk, with no additional effect of self-monitoring. For considering future approaches of cardiovascular risk reduction, cost effectiveness analyses of regular care and additional self-monitoring are performed from a societal perspective on data from the SPRING-RCT.MethodsDirect medical and productivity costs are analysed alongside the SPRING-RCT, studying 179 participants (men aged 50–75 years, women aged 55–75 years), with an elevated cardiovascular risk, in 20 general practices in the Netherlands. Standard cardiovascular treatment according to Dutch guidelines is compared with additional counselling based on self-monitoring at home (pedometer, weighing scale and/ or blood pressure device) both by trained practice nurses. Cost-effectiveness is evaluated for both treatment groups and patient categories (age, sex, education).ResultsCosts are €98 and €187 per percentage decrease in 10-year cardiovascular mortality estimation, for the control and intervention group respectively. In both groups lost productivity causes the majority of the costs. The incremental cost-effectiveness ratio is approximately €1100 (95% CI: -5157 to 6150). Self-monitoring may be cost effective for females and higher educated participants, however confidence intervals are wide.ConclusionsIn this study population, regular treatment is more cost effective than counselling based on self-monitoring, with the majority of costs caused by lost productivity.Trial registrationTrialregister.nl identifier: http://NTR2188

Highlights

Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low
For the SPRING-Randomized controlled trial (RCT) we reported that combined lifestyle and drug intervention by practice nurses in persons with a mild to moderate cardiovascular risk resulted in a small but significant decrease of cardiovascular risk after one year (ΔSCORE 10 year risk of cardiovascular mortality –1.71% (SD 2.95) for both groups together), [15] without significant additional effect of intensive treatment with self-monitoring compared with standard treatment [16]
The mean difference between both groups regarding treatment effect is 0.16% Systematic coronary risk evaluation (SCORE) risk estimation

Summary

Introduction

Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. For considering future approaches of cardiovascular risk reduction, cost effectiveness analyses of regular care and additional self-monitoring are performed from a societal perspective on data from the SPRING-RCT. Annual costs at patient level were estimated for the Dutch situation, including doctor’s visits, repeat prescriptions, drug costs and Lifestyle interventions appear to be cost effective in reducing cardiovascular risk [5]. A Dutch study found that preventive cardiac medication, following a 2006 revised guideline, was cost effective [4]. This guideline recommended a broader indication for starting medication than previous guidelines and was the basis for SPRING study (Self-monitoring and Prevention of RIsk factors by Nurse practitioners in the region of Groningen), of which the cost effectiveness is discussed in this paper. There is a need for cost effectiveness-analysis of cardiovascular preventive interventions in general practice from a societal point of view

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