Cost analysis and cost-effectiveness of NT-proBNP-guided heart failure specialist care in addition to home-based nurse care

P>Background Heart failure management programmes have been shown to reduce re-hospitalizations. We recently investigated a new disease management programme comparing usual care (UC) to home-based nurse care (HNC) and a HNC group in which decision-making was based on NT-proBNP levels (BNC). As re-hospitalization is the main contributing economic factor in heart failure expenditures, we hypothesized that this programme might be able to reduce costs and could be conducted cost effectively compared to UC. Methods One hundred and ninety congestive heart failure patients, who were included in a randomized trial to receive UC, HNC or BNC at discharge, were analysed in a cost-effectiveness model. Different models were applied to perform analysis of all medical costs, and the costs per year survived were chosen as an effectiveness parameter. Results Per patient costs because of heart failure treatment in the UC and the BNC group were euro7109 +/- 11 687 and euro2991 +/- 4885 (P = 0 center dot 027), respectively. Corrected for death as a competing risk, the costs in the UC group were euro7893 +/- 11 734 and were reduced by BNC to euro3148 +/- 4949 (P = 0 center dot 012). Considering costs because of all-cause re-hospitalizations, calculated costs per year survived after discharge were euro19 694 +/- 26 754 for UC, euro14 262 +/- 25 330 for HNC (P > 0 center dot 05) and euro8784 +/- 14 728 for BNC (t-test-based contrast P = 0 center dot 015). In all models calculated, HNC was cost neutral. Conclusions NT-BNP-guided heart failure specialist care in addition to home-based nurse care is cost effective and cheaper than standard care, whereas HNC is cost neutral.