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

doi:10.1136/bmjopen-2014-007128

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^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Article number	e007128
Number of pages	9
Journal	BMJ open [E]
Volume	5
Issue number	5
DOIs	https://doi.org/10.1136/bmjopen-2014-007128
Publication status	Published - 1 Jan 2015

Keywords

CORONARY-HEART-DISEASE
PREVENTION
COUNTRIES
OUTCOMES
UTILITY
HEALTH
ADULTS
CARE

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Greving, J. P., Kaasjager, H. A. H., Vernooij, J. W. P., Hovens, M. M. C., Wierdsma, J., Grandjean, H. M. H., Van Der Graaf, Y., De Wit, G. A., & Visseren, F. L. J. (2015). Cost-effectiveness of a nurse-led internet-based vascular risk factor management programme: Economic evaluation alongside a randomised controlled clinical trial. BMJ open [E], 5(5), Article e007128. https://doi.org/10.1136/bmjopen-2014-007128

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title = "Cost-effectiveness of a nurse-led internet-based vascular risk factor management programme: Economic evaluation alongside a randomised controlled clinical trial",

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 = "CORONARY-HEART-DISEASE, PREVENTION, COUNTRIES, OUTCOMES, UTILITY, HEALTH, ADULTS, CARE",

author = "Greving, {J. P.} and Kaasjager, {H. A H} and J.W.P. Vernooij and Hovens, {M. M C} and J. Wierdsma and Grandjean, {H. M H} and {Van Der Graaf}, Y. and {De Wit}, {G. A.} and Visseren, {F. L J}",

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Greving, JP , Kaasjager, HAH, Vernooij, JWP, Hovens, MMC, Wierdsma, J, Grandjean, HMH, Van Der Graaf, Y , De Wit, GA & Visseren, FLJ 2015, 'Cost-effectiveness of a nurse-led internet-based vascular risk factor management programme: Economic evaluation alongside a randomised controlled clinical trial', BMJ open [E], vol. 5, no. 5, e007128. https://doi.org/10.1136/bmjopen-2014-007128

TY - JOUR

T1 - Cost-effectiveness of a nurse-led internet-based vascular risk factor management programme

T2 - Economic evaluation alongside a randomised controlled clinical trial

AU - Greving, J. P.

AU - Kaasjager, H. A H

AU - Vernooij, J.W.P.

AU - Hovens, M. M C

AU - Wierdsma, J.

AU - Grandjean, H. M H

AU - Van Der Graaf, Y.

AU - De Wit, G. A.

AU - Visseren, F. L J

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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.

AB - 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.

KW - CORONARY-HEART-DISEASE

KW - PREVENTION

KW - COUNTRIES

KW - OUTCOMES

KW - UTILITY

KW - HEALTH

KW - ADULTS

KW - CARE

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U2 - 10.1136/bmjopen-2014-007128

DO - 10.1136/bmjopen-2014-007128

M3 - Article

C2 - 25995238

AN - SCOPUS:84930226978

SN - 2044-6055

VL - 5

JO - BMJ open [E]

JF - BMJ open [E]

IS - 5

M1 - e007128

ER -

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

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