Cost-effectiveness of an inpatient nurse practitioner in heart failure.

Abstract

Heart failure (HF) nurse practitioners (NP) are an important part of the HF specialist team and their impact on the cost-effectiveness of their role is unknown. The aim of this study was to determine the cost effectiveness of a HF NP inpatient service compared to current practice of no HF NP service from a health system perspective at 12 months and three years. We developed a Markov model to estimate costs, effects and cost-effectiveness for hospitalised HF patients and seen by a HF NP service compared to usual care at 12 months and 3 years. Costs and effects were taken from a retrospective observational cohort study. Transition probabilities and utilities were derived from published studies.A total of 500 patients were included (250 patients in the HF NP service vs 250 patients in usual care). Average age was 77.7 +11 years and 54% were male. At 12 months, the HF NP group was cheaper and more effective compared to no HF NP ($23 031 vs $25 111 (AUD) respectively; quality adjusted life-years (QALYs) were 0.68 in HF NP group compared to 0.66 in usual care). The incremental cost effectiveness ratio showed a savings of $109 474 per QALY gained at 12 months and a savings of $270 667 per QALY gained at three years in favour of the HF NP service. The HF NP service was cost-effective with lower costs and higher QALYs compared to no HF NP service. Economic evaluations alongside RCTs are warranted.