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The European Journal of Health Economics

, Volume 16, Issue 6, pp 671–681 | Cite as

Cost-effectiveness of nurse-based case management versus usual care for elderly patients with myocardial infarction: results from the KORINNA study

  • Hildegard SeidlEmail author
  • Matthias Hunger
  • Reiner Leidl
  • Christa Meisinger
  • Rupert Wende
  • Bernhard Kuch
  • Rolf Holle
Original Paper

Abstract

Objectives

We assessed the cost-effectiveness of a case management intervention by trained nurses in elderly (≥65 years) patients with myocardial infarction from a societal perspective.

Methods

The intervention and observation period spanned 1 year 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.

Results

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 6 months 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 1 year 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 −€17.61 (CI − €2,601–€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).

Conclusions

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 1 year.

Keywords

Cost-effectiveness analysis Quality-adjusted life years Case management Myocardial infarction Elderly 

JEL Classification

I120 Health production 

Notes

Acknowledgments

The KORA research platform (KORA, Cooperative Research in the Region of Augsburg) was initiated and financed by the Helmholtz Zentrum München—German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research and by the State of Bavaria. The KORA-Age project was financed by the German Federal Ministry of Education and Research (BMBF FKZ 01ET0713) as part of the ‘Health in old age’ programme. We thank all members of the Helmholtz Zentrum München who were involved in the conduct of the study. Furthermore, we wish to thank the field staff in Augsburg, especially Barbara Dick, Claudia Greschik, Birgit Kling, Dorothea Lukitsch, Sonja Reiserer, and Gisela Sietas.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Hildegard Seidl
    • 1
    Email author
  • Matthias Hunger
    • 1
  • Reiner Leidl
    • 1
  • Christa Meisinger
    • 2
    • 3
  • Rupert Wende
    • 4
  • Bernhard Kuch
    • 5
  • Rolf Holle
    • 1
  1. 1.Institute of Health Economics and Health Care ManagementHelmholtz Zentrum München, German Research Center for Environmental Health (GmbH)NeuherbergGermany
  2. 2.KORA Myocardial Infarction RegistryCentral Hospital of AugsburgAugsburgGermany
  3. 3.Institute of Epidemiology IIHelmholtz Zentrum München, German Research Center for Environmental Health (GmbH)NeuherbergGermany
  4. 4.Department of Internal Medicine I/CardiologyCentral Hospital of AugsburgAugsburgGermany
  5. 5.Department for Internal Medicine/CardiologyDonau-Ries-KlinikenNördlingenGermany

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