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

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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.

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References

  1. World Health Organization: The top 10 causes of death http://who.int/mediacentre/factsheets/fs310/en/. Accessed 15 Oct 2013

  2. Mannsverk, J., Wilsgaard, T., Njolstad, I., Hopstock, L.A., Lochen, M.L., Mathiesen, E.B., Thelle, D.S., Rasmussen, K., Bonaa, K.H.: Age and gender differences in incidence and case fatality trends for myocardial infarction: a 30-year follow-up. The Tromso Study. Eur J Prev cardiol 19(5), 927–934 (2012)

    Article  PubMed  Google Scholar 

  3. Robert Koch Institute, Telephone Health Survey (GEDA): Coronary heart diseases, diagnosed by a physician. http://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/dboowasys921.xwdevkit/xwd_init?gbe.isgbetol/xs_start_neu/&p_aid=i&p_aid=6990894&nummer=762&p_sprache=E&p_indsp=-&p_aid=97416972. Accessed May 2014

  4. Fleg, J.L., Forman, D.E., Berra, K., Bittner, V., Blumenthal, J.A., Chen, M.A., Cheng, S., Kitzman, D.W., Maurer, M.S., Rich, M.W., Shen, W.K., Williams, M.A., Zieman, S.J.: Secondary prevention of atherosclerotic cardiovascular disease in older adults: a scientific statement from the American Heart Association. Circ 128(22), 2422–2446 (2013). doi:10.1161/01.cir.0000436752.99896.22

    Article  Google Scholar 

  5. Kotseva, K., Wood, D., De Backer, G., De Bacquer, D.: Use and effects of cardiac rehabilitation in patients with coronary heart disease: results from the EUROASPIRE III survey. Eur J Prev Cardiol 20(5), 817–826 (2013). doi:10.1177/2047487312449591

    Article  PubMed  Google Scholar 

  6. Clark, A.M., Haykowsky, M., Kryworuchko, J., MacClure, T., Scott, J., DesMeules, M., Luo, W., Liang, Y., McAlister, F.A.: A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease. Eur J Cardiovasc Prev Rehabil 17(3), 261–270 (2010)

    PubMed  Google Scholar 

  7. McAlister, F.A., Lawson, F.M., Teo, K.K., Armstrong, P.W.: A systematic review of randomized trials of disease management programs in heart failure. Am. J. Med. 110(5), 378–384 (2001)

    Article  CAS  PubMed  Google Scholar 

  8. Schadewaldt, V., Schultz, T.: Nurse-led clinics as an effective service for cardiac patients: results from a systematic review. Int J Evid-Based Healthc 9(3), 199–214 (2011). doi:10.1111/j.1744-1609.2011.00217.x

    PubMed  Google Scholar 

  9. Stolic, S., Mitchell, M., Wollin, J.: Nurse-led telephone interventions for people with cardiac disease: a review of the research literature. Eur J Cardiovasc Nurs 9(4), 203–217 (2010). doi:10.1016/j.ejcnurse.2010.02.003

    Article  PubMed  Google Scholar 

  10. Raftery, J.P., Yao, G.L., Murchie, P., Campbell, N.C., Ritchie, L.D.: Cost effectiveness of nurse-led secondary prevention clinics for coronary heart disease in primary care: follow-up of a randomised controlled trial. BMJ 330(7493), 707 (2005). doi:10.1136/bmj.38342.665417.8F

    Article  PubMed Central  PubMed  Google Scholar 

  11. Turkstra, E., Hawkes, A.L., Oldenburg, B., Scuffham, P.A.: Cost-effectiveness of a coronary heart disease secondary prevention program in patients with myocardial infarction: results from a randomised controlled trial (ProActive Heart). BMC Cardiovasc Disord 13(1), 33 (2013). doi:10.1186/1471-2261-13-33 18

    Article  PubMed Central  PubMed  Google Scholar 

  12. Turner, D.A., Paul, S., Stone, M.A., Juarez-Garcia, A., Squire, I., Khunti, K.: Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care. Heart 94(12), 1601–1606 (2008). doi:10.1136/hrt.2007.125708

    Article  CAS  PubMed  Google Scholar 

  13. Hebert, P.L., Sisk, J.E., Wang, J.J., Tuzzio, L., Casabianca, J.M., Chassin, M.R., Horowitz, C., McLaughlin, M.A.: Cost-effectiveness of nurse-led disease management for heart failure in an ethnically diverse urban community. Ann. Intern. Med. 149(8), 540–548 (2008)

    Article  PubMed Central  PubMed  Google Scholar 

  14. Postmus, D., Pari, A.A., Jaarsma, T., Luttik, M.L., van Veldhuisen, D.J., Hillege, H.L., Buskens, E.: A trial-based economic evaluation of 2 nurse-led disease management programs in heart failure. Am. Heart J. 162(6), 1096–1104 (2011). doi:10.1016/j.ahj.2011.09.019

    Article  PubMed  Google Scholar 

  15. Smith, B., Hughes-Cromwick, P.F., Forkner, E., Galbreath, A.D.: Cost-effectiveness of telephonic disease management in heart failure. Am J Manag Care 14(2), 106–115 (2008). Pii: 7020

    PubMed  Google Scholar 

  16. Kirchberger, I., Meisinger, C., Seidl, H., Wende, R., Kuch, B., Holle, R.: Nurse-based case management for aged patients with myocardial infarction: study protocol of a randomized controlled trial. BMC geriatr 10, 29 (2010)

    Article  PubMed Central  PubMed  Google Scholar 

  17. Meisinger, C., Stollenwerk, B., Kirchberger, I., Seidl, H., Wende, R., Kuch, B., Holle, R.: Effects of a nurse-based case management compared to usual care among aged patients with myocardial infarction: results from the randomized controlled KORINNA study. BMC Geriatr 13(1), 115 (2013). doi:10.1186/1471-2318-13-115

    Article  PubMed Central  PubMed  Google Scholar 

  18. Hunger, M., Kirchberger, I., Holle, R., Seidl, H., Kuch, B., Wende, R., Meisinger, C.: Does nurse-based case management for aged myocardial infarction patients improve risk factors, physical functioning and mental health? The KORINNA trial. Eur J Prev Cardiol (2014). doi:10.1177/2047487314524682

    PubMed  Google Scholar 

  19. Stark, R., Kirchberger, I., Hunger, M., Heier, M., Leidl, R., von Scheidt, W., Meisinger, C., Holle, R.: Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines. Clini Res Cardiol:Off J Ger Card Soc. 103(3), 237–245 (2014). doi:10.1007/s00392-013-0643-5

    Article  Google Scholar 

  20. Nowels, D., McGloin, J., Westfall, J.M., Holcomb, S.: Validation of the EQ-5D quality of life instrument in patients after myocardial infarction. Qual. Life Res. 14(1), 95–105 (2005)

    Article  PubMed  Google Scholar 

  21. Schweikert, B., Hahmann, H., Leidl, R.: Validation of the EuroQol questionnaire in cardiac rehabilitation. Heart 92(1), 62–67 (2006). doi:10.1136/hrt.2004.052787

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Russell, K., Freeman, A., Blue, L., Stewart, S.: a blueprint for identifying and managing patients within a heart failure Service. 2nd eds. In: Improving Outcomes in Chronic Heart Failure: Specialist Nurse Intervention from Research to Practice. BMJ Publishing Group, London (2004)

  23. Greiner, W., Claes, C., Busschbach, J.J., von der Schulenburg, J.M.: Validating the EQ-5D with time trade off for the German population. Eur J Health Econ 6(2), 124–130 (2005)

    Article  CAS  PubMed  Google Scholar 

  24. Drummond, M.F., Sculpher, M.J., Torrance, G.W., O’Brien, B.J., Stoddart, G.L.: Methods for the economic evaluation of health care programmes. 3rd ed. Oxford University Press, Oxford (2005) 19

  25. Goossens, M.E.: Rutten-van Molken, M.P., Vlaeyen, J.W., van der Linden, S.M.: The cost diary: a method to measure direct and indirect costs in cost-effectiveness research. J. Clin. Epidemiol. 53(7), 688–695 (2000). Pii: S0895435699001778

    Article  CAS  PubMed  Google Scholar 

  26. Seidl, H., Meisinger, C., Wende, R., Holle, R.: Empirical analysis shows reduced cost data collection may be an efficient method in economic clinical trials. BMC Health Serv Res 12, 318 (2012). doi:10.1186/1472-6963-12-318

    Article  PubMed Central  PubMed  Google Scholar 

  27. Krauth, C., Hessel, F., Hansmeier, T., Wasem, J., Seitz, R., Schweikert, B.: Empirical standard costs for health economic evaluation in Germany—a proposal by the working group methods in health economic evaluation. Gesundheitswesen 67(10), 736–746 (2005). doi:10.1055/s-2005-858698

    Article  CAS  PubMed  Google Scholar 

  28. GKV-Heilmittel-Informationssystem.http://www.gkv-his.de/Aktuelle_Quartalsberichte.gkvnet. (Accessed 12 Jan 2013)

  29. Standardtarif http://www.debeka.de/service/bedingungen/Krankenversicherung/Allgemeine_Bedingungen/CKV50.pdf. (Accessed 13 Dec 2012)

  30. Rehabilitation. http://www.deutsche-rentenversicherung-bund.de/cae/servlet/contentblob/89948/publicationFile/19214/statistikband_reha_2010_pdf.pdf;jsessionid=564C005D3595BEEC1AB4D126E3B6AC84.cae03. (Accessed 26 Jan 2013)

  31. Vertrag gemäß § 89 SGB XI (2010) http://www.aok-gesundheitspartner.de/imperia/md/gpp/by/pflege/ambulant/by_pflege_amb_pv_vergut_vertrag_anlage3_leistungskomplexe_wohlfahrt.pdf. (Accessed 15 April 2013)

  32. Mühlberger, N., Behrend, C., Stark, R., Holle, R.: Database-supported identification and entry of drug data in health studies—experience with the IDOM software [Datenbankgestützte Online-Erfassung von Arzneimitteln im Rahmen gesundheitswissenschaftlicher Studien Erfahrungen mit der IDOM-Software] in German. Inform Biom Epidemiol Med Biol 34(4), 601–611 (2003)

    Google Scholar 

  33. Wissenschaftliches Institut der AOK. http://www.wido.de/arzneimittel.html. Accessed 15 January 2013

  34. Sozialgesetzbuch (SGB), Elftes Buch (XI), Soziale Pflegeversicherung. http://www.sozialgesetzbuch-sgb.de/sgbxi/1.html. Accessed 15 Apr 2011

  35. Manca, A., Hawkins, N., Sculpher, M.J.: Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ. 14(5), 487–496 (2005). doi:10.1002/hec.944

    Article  PubMed  Google Scholar 

  36. Kahan, B.C., Morris, T.P.: Improper analysis of trials randomised using stratified blocks or minimisation. Stat. Med. 31(4), 328–340 (2012). doi:10.1002/sim.4431

    Article  PubMed  Google Scholar 

  37. Molenberghs, G., Kenward, M.G.: Missing data in clinical studies. John Wiley & Sons Ltd, UK (2007)

    Book  Google Scholar 

  38. Dodd, S., Bassi, A., Bodger, K., Williamson, P.: A comparison of multivariable regression models to analyse cost data. J Eval Clin Pract 12(1), 76–86 (2006). doi:10.1111/j.1365-2753.2006.00610.x

    Article  PubMed  Google Scholar 

  39. Glick, H., Doshi, J.A., Sonnad, S.S., Polsky, D.: Economic evaluation in clinical trials. In: Gray, A., Briggs, A. (eds.) Handbooks in health economic evaluation series. Oxford University Press, New York (2007)

  40. Graubard, B.I., Korn, E.L.: Predictive margins with survey data. Biometrics 55(2), 652–659 (1999)

    Article  CAS  PubMed  Google Scholar 

  41. Husereau, D., Drummond, M., Petrou, S., Carswell, C., Moher, D., Greenberg, D., Augustovski, F., Briggs, A.H., Mauskopf, J., Loder, E.: Consolidated Health Economic Evaluation Reporting Standards (CHEERS)–explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Val Health 16(2), 231–250 (2013). doi:10.1016/j.jval.2013.02.002

    Article  Google Scholar 

  42. Briggs, A.H., Lozano-Ortega, G., Spencer, S., Bale, G., Spencer, M.D., Burge, P.S.: Estimating the cost-effectiveness of fluticasone propionate for treating chronic obstructive pulmonary disease in the presence of missing data. Val Health 9(4), 227–235 (2006). doi:10.1111/j.1524-4733.2006.00106.x

    Article  Google Scholar 

  43. Horton, N.J., SR, L.: Multiple imputation in practice: comparison of software packages for regression models with missing variables. Am Statistician 55, 244–254 (2001)

    Article  Google Scholar 

  44. Ramsey, S., Willke, R., Briggs, A., Brown, R., Buxton, M., Chawla, A., Cook, J., Glick, H., Liljas, B., Petitti, D., Reed, S.: Good research practices for cost-effectiveness analysis alongside clinical trials: the ISPOR RCT-CEA Task Force report. Val Health 8(5), 521–533 (2005). doi:10.1111/j.1524-4733.2005.00045.x

    Article  Google Scholar 

  45. Sahlen, K.G., Lofgren, C., Brodin, H., Dahlgren, L., Lindholm, L.: Measuring the value of older peopleʼs production: a diary study. BMC Health Serv Res 12, 4 (2012). doi:10.1186/1472-6963-12-4

    Article  PubMed Central  PubMed  Google Scholar 

  46. Leidl, R., Reitmeir, P.: A value set for the EQ-5D based on experienced health states: development and testing for the German population. Pharmacoecon 29(6), 521–534 (2011). doi:10.2165/11538380-000000000-00000

    Article  Google Scholar 

  47. Broome, J.: QALYs. J public econ 50, 149–167 (1993)

    Article  Google Scholar 

  48. Dolan, P., Kahneman, D.: Interpretations of utility and their implications for the valuation of health. Econ. J. 118(525), 215–234 (2008)

    Article  Google Scholar 

  49. Parkin, D., Devlin, N.: Is there a case for using visual analogue scale valuations in cost-utility analysis? Health Econ. 15(7), 653–664 (2006). doi:10.1002/hec.1086

    Article  PubMed  Google Scholar 

  50. Hawkes, A.L., Atherton, J., Taylor, C.B., Scuffham, P., Eadie, K., Miller, N.H., Oldenburg, B.: Randomised controlled trial of a secondary prevention program for myocardial infarction patients ('ProActive Heart'): study protocol. Secondary prevention program for myocardial infarction patients. BMC Cardiovasc Disord 9, 16 (2009). doi:10.1186/1471-2261-9-16

    Article  PubMed Central  PubMed  Google Scholar 

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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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Authors and Affiliations

  1. Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany

    Hildegard Seidl, Matthias Hunger, Reiner Leidl & Rolf Holle

  2. KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany

    Christa Meisinger

  3. Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany

    Christa Meisinger

  4. Department of Internal Medicine I/Cardiology, Central Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany

    Rupert Wende

  5. Department for Internal Medicine/Cardiology, Donau-Ries-Kliniken, Stoffelsberg 4, 86720, Nördlingen, Germany

    Bernhard Kuch

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  1. Hildegard Seidl
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  2. Matthias Hunger
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  3. Reiner Leidl
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Correspondence to Hildegard Seidl.

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Seidl, H., Hunger, M., Leidl, R. et al. Cost-effectiveness of nurse-based case management versus usual care for elderly patients with myocardial infarction: results from the KORINNA study. Eur J Health Econ 16, 671–681 (2015). https://doi.org/10.1007/s10198-014-0623-3

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  • DOI: https://doi.org/10.1007/s10198-014-0623-3

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