School of Nursing and Midwifery, Deakin University, Geelong, Australia.
Department of Cardiology, Austin Health, Melbourne, Australia.
Eur J Cardiovasc Nurs. 2024 Jan 12;23(1):33-41. doi: 10.1093/eurjcn/zvad036.
Heart failure (HF) nurse practitioners (NPs) 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 with current practice of no HF NP service from a health system perspective at 12 months and 3 years.
We developed a Markov model to estimate costs, effects, and cost-effectiveness for hospitalized HF patients and seen by a HF NP service compared with 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 with no HF NP [$23 031 vs. $25 111 (AUD), respectively; quality-adjusted life years (QALYs) were 0.68 in HF NP group compared with 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 3 years in favour of the HF NP service.
The HF NP service was cost-effective with lower costs and higher QALYs compared with no HF NP service. Economic evaluations alongside randomized controlled trials are warranted.
心力衰竭（HF）护士从业者（NP）是 HF 专家团队的重要组成部分，但其在角色成本效益方面的影响尚不清楚。本研究旨在从卫生系统角度确定 HF NP 住院服务与目前无 HF NP 服务相比，在 12 个月和 3 年内的成本效益。
我们开发了一个马尔可夫模型，以估计 HF NP 服务与常规护理相比，在 12 个月和 3 年内住院 HF 患者的成本、效果和成本效益。成本和效果来自回顾性观察队列研究。转移概率和效用来自已发表的研究。共纳入 500 名患者（HF NP 服务组 250 名，常规护理组 250 名）。平均年龄为 77.7 ± 11 岁，54%为男性。在 12 个月时，HF NP 组的成本低于常规护理组，效果优于常规护理组[分别为 23031 澳元与 25111 澳元（AUD）；HF NP 组的质量调整生命年（QALY）为 0.68，常规护理组为 0.66]。增量成本效益比显示，12 个月时，每获得一个 QALY 可节省 109474 澳元，3 年时可节省 270667 澳元，HF NP 服务更具成本效益。
与无 HF NP 服务相比，HF NP 服务具有成本效益，成本更低，QALY 更高。需要进行经济评估与随机对照试验。
