Key result
Standard cardiovascular risk management by practice nurses was more cost-effective than additional intensive counseling based on self-monitoring, with an incremental cost-effectiveness ratio of €1082 per 1% extra decrease in SCORE risk estimation.
Why the study?
Does additional counselling based on self-monitoring improve the cost-effectiveness of cardiovascular risk management by practice nurses in primary care patients with elevated cardiovascular risk?
RCT (n=179)
Randomised at patient level
Yes
Does additional counselling based on self-monitoring improve the cost-effectiveness of cardiovascular risk management by practice nurses in primary care patients with elevated cardiovascular risk?
In primary care patients with elevated cardiovascular risk, standard cardiovascular risk management by practice nurses is more cost-effective than adding intensive counselling based on self-monitoring, largely due to productivity losses from extra visits.
Standard nurse-led CV risk management is more cost-effective than intensive add-on counseling; extends RCT evidence prioritizing basic strategies in primary care.
BACKGROUND: Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. The randomised controlled SPRING-trial (SPRING-RCT) shows that cardiovascular risk management by practice nurses in general practice with and without self-monitoring both decreases cardiovascular risk, with no additional effect of self-monitoring. For considering future approaches of cardiovascular risk reduction, cost effectiveness analyses of regular care and additional self-monitoring are performed from a societal perspective on data from the SPRING-RCT. METHODS: Direct medical and productivity costs are analysed alongside the SPRING-RCT, studying 179 participants (men aged 50-75 years, women aged 55-75 years), with an elevated cardiovascular risk, in 20 general practices in the Netherlands. Standard cardiovascular treatment according to Dutch guidelines is compared with additional counselling based on self-monitoring at home (pedometer, weighing scale and/ or blood pressure device) both by trained practice nurses. Cost-effectiveness is evaluated for both treatment groups and patient categories (age, sex, education). RESULTS: Costs are €98 and €187 per percentage decrease in 10-year cardiovascular mortality estimation, for the control and intervention group respectively. In both groups lost productivity causes the majority of the costs. The incremental cost-effectiveness ratio is approximately €1100 (95% CI: -5157 to 6150). Self-monitoring may be cost effective for females and higher educated participants, however confidence intervals are wide. CONCLUSIONS: In this study population, regular treatment is more cost effective than counselling based on self-monitoring, with the majority of costs caused by lost productivity. TRIAL REGISTRATION: Trialregister.nl identifier: http://NTR2188.
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Tiessen et al. (2013) conducted an RCT in Elevated cardiovascular risk (n=179). Standard cardiovascular treatment plus counselling based on self-monitoring at home vs. Standard cardiovascular treatment was evaluated on Decrease in SCORE 10-year risk of fatal cardiovascular disease (Mean difference 0.16, 95% CI -1.66 to 1.98). Standard cardiovascular risk management by practice nurses was more cost-effective than additional intensive counseling based on self-monitoring, with an incremental cost-effectiveness ratio of €1082 per 1% extra decrease in SCORE risk estimation.
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