Cost-effectiveness of a nurse-led internet-based vascular risk factor management programme: economic evaluation alongside a randomised controlled clinical trial

J P Greving, H A H Kaasjager, J W P Vernooij, M M C Hovens, J Wierdsma, H M H Grandjean, Y van der Graaf, G A de Wit, F L J Visseren, J P Greving, H A H Kaasjager, J W P Vernooij, M M C Hovens, J Wierdsma, H M H Grandjean, Y van der Graaf, G A de Wit, F L J Visseren

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.

Keywords: EPIDEMIOLOGY; HEALTH ECONOMICS; VASCULAR MEDICINE.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Trial profile.
Figure 2
Figure 2
(A) Incremental costs and quality-adjusted life-years (QALYs) for a nurse-led, internet-based vascular risk factor management programme compared with usual care: cost-effectiveness plane for incremental costs and QALYs at 1 year, with CE threshold line (€20 000/QALY). (B) Cost-effectiveness acceptability curve showing the probability that a nurse-led, internet-based vascular risk factor management programme is cost-effective compared with usual care over a range of societal willingness-to-pay values.

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