Abstract
We assessed the cost-effectiveness of a case management intervention by trained nurses in elderly (≥65years) patients with myocardial infarction from a societal perspective. The intervention and observation period spanned 1year and 329 participants were enrolled. The intervention consisted of at least one home visit and quarterly telephone calls. Data on resource use and quality of life were collected quarterly. The primary measurements of effect were quality-adjusted life years (QALYs), based on the EuroQol five-dimensional questionnaire (EQ-5D-3L) health utilities from the German time trade-off. The secondary measurements were EQ-5D-3L utility values and patients' self-rated health states according to the visual analogue scale (VAS) among survivors. To estimate mean differences, a linear regression model was used for QALYs and a gamma model for costs. Health states among the survivors were analysed using linear mixed models. To assess the impact of different health state valuation methods, VAS-adjusted life years were constructed. The mean difference in QALYs was small and not significant (-0.0163; CI -0.0681-0.0354, p value: 0.536, n=297). Among survivors, EQ-5D-3L utilities showed significant improvements within 6months in the intervention group (0.051; CI 0.0028-0.0989; p value: 0.0379, n=280) but returned towards baseline levels by month 12. The mean improvement in self-rated health (VAS) within 1year was significantly larger in the intervention group (+9.2, CI 4.665-13.766, p value:<0.0001, n=266). The overall cost difference was -<euro>17.61 (CI-<euro>2,601-<euro>2,615; p value: 0.9856, n=297). The difference in VAS-adjusted life years was 0.0378 (CI -0.0040-0.0796, p value: 0.0759, n=297). This study could not provide evidence to conclude that the case management intervention was an effective and cost-effective alternative to usual care within a time horizon of 1year.
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