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Primary Care

Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: follow up of a randomised controlled trial

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38342.665417.8F (Published 24 March 2005) Cite this as: BMJ 2005;330:707
  1. James P Raftery, professor (j.p.raftery{at}bham.ac.uk)1,
  2. Guiqing L Yao, research fellow1,
  3. Peter Murchie, Cancer Research UK research training fellow in primary care oncology2,
  4. Neil C Campbell, senior lecturer2,
  5. Lewis D Ritchie, Mackenzie professor of general practice2
  1. 1 Health Economics Facility, Health Services Management Centre, University of Birmingham, Birmingham B15 2RT,
  2. 2 Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY
  1. Correspondence to: J P Raftery
  • Accepted 17 December 2004

Abstract

Objective To establish the cost effectiveness of nurse led secondary prevention clinics for coronary heart disease based on four years' follow up of a randomised controlled trial.

Design Cost effectiveness analysis.

Setting 19 general practices in north east Scotland.

Participants 1343 patients (673 in intervention group and 670 in control group, as originally randomised) aged under 80 years with a diagnosis of coronary heart disease but without terminal illness or dementia and not housebound.

Intervention Nurse led clinics to promote medical and lifestyle components of secondary prevention.

Main outcome measures Costs of clinics; overall costs to health service; and cost per life year and per quality adjusted life year (QALY) gained, expressed as incremental gain in intervention group compared with control group.

Results The cost of the intervention (clinics and drugs) was £136 ($254; €195) per patient higher (1998-9 prices) in the intervention group, but the difference in other NHS costs, although lower for the intervention group, was not statistically significant. Overall, 28 fewer deaths occurred in the intervention group leading to a gain in mean life years per patient of 0.110 and of 0.124 QALYs. The incremental cost per life year saved was £1236 and that per QALY was £1097.

Conclusion Nurse led clinics for the secondary prevention of coronary heart disease in primary care seem to be cost effective compared with most interventions in health care, with the main gains in life years saved.

Footnotes

  • Contributors JPR, PM, NCC, and LDR designed the study. PM and NCC collected the data. JPR, GLY, PM, and NCC analysed the data. JPR, GLY, PM, NCC, and LDR wrote the paper. JPR is guarantor.

  • Funding The original trial and four year follow up study was funded by the Chief Scientist Office of the Scottish Executive. All researchers are independent of the Chief Scientist Office of the Scottish Executive.

  • Competing interests None declared.

  • Ethical approval The original trial and follow up study was approved by the Grampian research ethics committee.

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