Cost-effectiveness analysis of nurse practitioner-led care for patients with heart failure in Japan

Abstract Background Heart failure (HF) is a leading cause of hospitalization and mortality in Japan. As its population ages rapidly, Japan is projected to experience an “HF pandemic” by 2030, placing an unprecedented burden on health care systems. Owing to increasing physician shortages and regional disparities in access to care, nurse practitioner (NP)-led care has been proposed as a promising strategy for sustainable HF management. However, no cost-effectiveness analysis of NP-led care for patients with HF has been conducted in Japan. Methods We developed a monthly cycle microsimulation Markov model over a 10-year horizon to compare NP-led care plus usual care versus usual care alone for hospitalized patients with HF in Japan (mean age: 76.5 years) from a health care payer perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained, with a willingness-to-pay (WTP) threshold of JPY 5,000,000. A 2% annual discount rate was applied to both costs and outcomes. Deterministic and probabilistic sensitivity analyses were performed. Results NP-led care yielded 3.54 QALYs versus 3.19 for usual care at costs of JPY 2,836,905 versus JPY 2,737,740, respectively. The base-case ICER was JPY 278,680 per QALY, which was below the WTP threshold. Under a conservative scenario in which the effect of NP-led care on readmission was reduced by 50%, the ICER was JPY 676,239 per QALY. Conclusion NP-led care for patients with HF was cost-effective across a range of sensitivity analyses, supporting its potential as a cost-effective strategy to support HF management in Japan.