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Open Access Research article

Cost-effectiveness of cardiovascular risk management by practice nurses in primary care

Ans H Tiessen1*, Karin M Vermeulen2, Jan Broer3, Andries J Smit4 and Klaas van der Meer1

Author Affiliations

1 University Medical Center Groningen, Department General Practice, University of Groningen, Groningen, The Netherlands

2 University Medical Center Groningen, Department Epidemiology, University of Groningen, Groningen, The Netherlands

3 Municipal Public Health Service Groningen, Groningen, The Netherlands

4 University Medical Center Groningen, Department Internal Medicine, University of Groningen, Groningen, The Netherlands

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BMC Public Health 2013, 13:148  doi:10.1186/1471-2458-13-148

Published: 18 February 2013



Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. The randomised controlled SPRING-trial (SPRING-RCT) shows that cardiovascular risk management by practice nurses in general practice with and without self-monitoring both decreases cardiovascular risk, with no additional effect of self-monitoring. For considering future approaches of cardiovascular risk reduction, cost effectiveness analyses of regular care and additional self-monitoring are performed from a societal perspective on data from the SPRING-RCT.


Direct medical and productivity costs are analysed alongside the SPRING-RCT, studying 179 participants (men aged 50–75 years, women aged 55–75 years), with an elevated cardiovascular risk, in 20 general practices in the Netherlands. Standard cardiovascular treatment according to Dutch guidelines is compared with additional counselling based on self-monitoring at home (pedometer, weighing scale and/ or blood pressure device) both by trained practice nurses. Cost-effectiveness is evaluated for both treatment groups and patient categories (age, sex, education).


Costs are €98 and €187 per percentage decrease in 10-year cardiovascular mortality estimation, for the control and intervention group respectively. In both groups lost productivity causes the majority of the costs. The incremental cost-effectiveness ratio is approximately €1100 (95% CI: -5157 to 6150). Self-monitoring may be cost effective for females and higher educated participants, however confidence intervals are wide.


In this study population, regular treatment is more cost effective than counselling based on self-monitoring, with the majority of costs caused by lost productivity.

Trial registration identifier: http://NTR2188 webcite

Cost-effectiveness; Arteriosclerosis; Cardiovascular diseases; Primary health care; Prevention and control; Self-management