BMJ  2005;330:707 (26 March), doi:10.1136/bmj.38342.665417.8F (published 16 February 2005)

Primary care

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

James P Raftery, professor1, Guiqing L Yao, research fellow1, Peter Murchie, Cancer Research UK research training fellow in primary care oncology2, Neil C Campbell, senior lecturer2, Lewis D Ritchie, Mackenzie professor of general practice2

1 Health Economics Facility, Health Services Management Centre, University of Birmingham, Birmingham B15 2RT, 2 Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY

Correspondence to: J P Raftery j.p.raftery{at}bham.ac.uk

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; {euro}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.


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