OBJECTIVE: To determine the cost-effectiveness of specialist nurse-led clinics provided to improve lipid and blood pressure control in diabetic patients receiving hospital-based care. RESEARCH DESIGN AND METHODS: A policy of targeting improved care through specialist nurse-led clinics is evaluated using a novel method, linking the cost-effectiveness of antihypertensive and lipid-lowering treatments with the cost and level of behavioral change achieved by the specialist nurse-led clinics. Treatment cost-effectiveness is modeled from the U.K. Prospective Diabetes Study and Heart Protection Study treatment trials, whereas specialist nurse-led clinics are evaluated using the Specialist Nurse-Led Clinics to Improve Control of Hypertension and Hyperlipidemia in Diabetes (SPLINT) trial. RESULTS: Good lipid and blood pressure control are cost-effective treatment goals for patients with diabetes. Modeling findings from treatment trials, blood pressure lowering is estimated to be cost saving and life prolonging (-1,400 dollars/quality-adjusted life-year [QALY]), whereas lipid-lowering is estimated to be highly cost-effective (8,230 dollars/QALY). Investing in nurse-led clinics to help achieve these benefits imposes an addition on treatment cost-effectiveness leading to higher estimates: 4,020 dollars/QALY and 19,950 dollars/QALY, respectively. For both clinics combined, the estimated cost-effectiveness is 9,070 dollars/QALY. Using an acceptability threshold of 50,000 dollars/QALY, the likelihood that blood pressure-lowering clinics are cost-effective is 77%, lipid clinics 99%, and combined clinics 83%. CONCLUSIONS: A method is described for evaluating the cost-effectiveness of policies to change patient uptake of health care. Such policies are less attractive than treatment cost-effectiveness (which implies cost-less self-implementation). However, specialist nurse-led clinics, as an adjunct to hospital-based diabetic care, combining both lipid and blood pressure control, appear effective and likely to provide excellent value for money.
OBJECTIVE: To determine the cost-effectiveness of specialist nurse-led clinics provided to improve lipid and blood pressure control in diabeticpatients receiving hospital-based care. RESEARCH DESIGN AND METHODS: A policy of targeting improved care through specialist nurse-led clinics is evaluated using a novel method, linking the cost-effectiveness of antihypertensive and lipid-lowering treatments with the cost and level of behavioral change achieved by the specialist nurse-led clinics. Treatment cost-effectiveness is modeled from the U.K. Prospective Diabetes Study and Heart Protection Study treatment trials, whereas specialist nurse-led clinics are evaluated using the Specialist Nurse-Led Clinics to Improve Control of Hypertension and Hyperlipidemia in Diabetes (SPLINT) trial. RESULTS: Good lipid and blood pressure control are cost-effective treatment goals for patients with diabetes. Modeling findings from treatment trials, blood pressure lowering is estimated to be cost saving and life prolonging (-1,400 dollars/quality-adjusted life-year [QALY]), whereas lipid-lowering is estimated to be highly cost-effective (8,230 dollars/QALY). Investing in nurse-led clinics to help achieve these benefits imposes an addition on treatment cost-effectiveness leading to higher estimates: 4,020 dollars/QALY and 19,950 dollars/QALY, respectively. For both clinics combined, the estimated cost-effectiveness is 9,070 dollars/QALY. Using an acceptability threshold of 50,000 dollars/QALY, the likelihood that blood pressure-lowering clinics are cost-effective is 77%, lipid clinics 99%, and combined clinics 83%. CONCLUSIONS: A method is described for evaluating the cost-effectiveness of policies to change patient uptake of health care. Such policies are less attractive than treatment cost-effectiveness (which implies cost-less self-implementation). However, specialist nurse-led clinics, as an adjunct to hospital-based diabetic care, combining both lipid and blood pressure control, appear effective and likely to provide excellent value for money.
Authors: Verughese Jacob; Sajal K Chattopadhyay; Anilkrishna B Thota; Krista K Proia; Gibril Njie; David P Hopkins; Ramona K C Finnie; Nicolaas P Pronk; Thomas E Kottke Journal: Am J Prev Med Date: 2015-11 Impact factor: 5.043
Authors: Verughese Jacob; Sajal K Chattopadhyay; David P Hopkins; Jeffrey A Reynolds; Ka Zang Xiong; Christopher D Jones; Betsy J Rodriguez; Krista K Proia; Nicolaas P Pronk; John M Clymer; Ron Z Goetzel Journal: Am J Prev Med Date: 2019-03 Impact factor: 5.043
Authors: Verughese Jacob; Sajal K Chattopadhyay; Krista K Proia; David P Hopkins; Jeffrey Reynolds; Anilkrishna B Thota; Christopher D Jones; Daniel T Lackland; Kimberly J Rask; Nicolaas P Pronk; John M Clymer; Ron Z Goetzel Journal: Am J Prev Med Date: 2017-08-14 Impact factor: 5.043
Authors: Ching-Yun Wei; Ruben G W Quek; Guillermo Villa; Shravanthi R Gandra; Carol A Forbes; Steve Ryder; Nigel Armstrong; Sohan Deshpande; Steven Duffy; Jos Kleijnen; Peter Lindgren Journal: Pharmacoeconomics Date: 2017-03 Impact factor: 4.981
Authors: Sajal K Chattopadhyay; Verughese Jacob; Shawna L Mercer; David P Hopkins; Randy W Elder; Christopher D Jones Journal: Am J Prev Med Date: 2017-12 Impact factor: 5.043
Authors: Emily W Piercefield; Molly E Howard; Michael H Robinson; Cain Eric Kirk; Addison P Ragan; Sondra D Reese Journal: J Clin Hypertens (Greenwich) Date: 2016-12-05 Impact factor: 3.738