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European Heart Journal 2002 23(17):1369-1378; doi:10.1053/euhj.2001.3114
Copyright © 2002 by the European Society of Cardiology.
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An economic analysis of specialist heart failure nurse management in the U.K. Can we afford not to implement it?

S. Stewarta,b, L. Bluec, A. Walkerc, C. Morrisonb and J.J.V. Mcmurrayb,f1

a Department of Cardiology, The Queen Elizabeth Hospital/University of Adelaide, Australia
b the Clinical Research Initiative in Heart Failure, University of Glasgow, Glasgow, Scotland
c Greater Glasgow Health Board, Glasgow, Scotland, U.K.

revised November 27, 2001; accepted November 28, 2001

Abstract

Aims Hospital activity represents the major component of health care expenditure related to heart failure. This study evaluated the economic impact of applying specialist nurse management programmes that limit heart failure-related hospital readmissions within a whole population.

Methods Using a reliable and validated estimate of the current level and cost of heart failure-related hospital activity in the U.K., we determined the thresholds at which the actual cost of establishing and applying a national service based on three different models of specialist nurse management would be equal to the ‘cost’ of bed utilization associated with preventable hospital readmissions in the year 2000. The three models of care examined were home-based, clinic-based or a combination of home plus clinic-based, post-discharge follow-up. The potential impact of this service was based on a U.K.-wide caseload of 122000 patients discharged to home with a discharge diagnosis of congestive heart failure in that year.

Results Based on heart failure-specific patterns of hospital activity, we estimate that 47000 of these 122000 patients would normally accumulate a total of 594000 days of associated hospital stay from 49000 readmissions (for any reason) within 1 year of hospital discharge. The cost of these admissions to the National Health Service was calculated at £166·2 million. Taking into account other costs associated with such hospital activity (e.g. general practice and hospital outpatient visits) each 10% reduction in recurrent bed utilization would be associated with £18·0 million in cost savings. Alternatively, the cost of applying a U.K.-wide programme of home-, clinic- or home plus clinic-based follow-up was calculated to be £69·4, £73·1 and £72·5 million per annum, respectively. The relative thresholds at which generated ‘cost-savings’ would equal the cost of applying these programmes of care would therefore be a 38·5%, 40·6% and 40·3% reduction in recurrent bed utilization, respectively. If, as expected, a home-based programme of specialist nurse management reduced recurrent bed utilization by 50% or more, annual savings equivalent to £169000 per 1000 patients treated would be generated.

Conclusions This is the first study to examine the economic consequences of applying a specialist nurse-mediated, post-discharge management service for heart failure within a whole population. Our findings suggest that such a service will not only improve quality of life and reduce readmissions in patients with congestive heart failure, but also reduce costs and improve the efficiency of the health care system in doing so. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

Key Words: Heart failure, cost evaluation, morbidity, hospitalization, nurse intervention

f1 Correspondence: Professor John McMurray, CRI in Heart Failure, Wolfson Building, University of Glasgow, Glasgow, U.K.

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