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- Title
Economic evaluation of nurse-led intensive care follow-up programmes compared with standard care: the PRaCTICaL trial.
- Authors
Hernández, R.; Jenkinson, D.; Vale, L.; Cuthbertson, B.
- Abstract
Objective: Following intensive care discharge, many patients suffer severe physical and psychological morbidity and a continuing high use of health services. Follow-up programmes have been proposed to improve the outcomes for these patients. We tested the hypothesis that nurse-led intensive care follow-up programmes are cost-effective. Methods: A pragmatic, multicentre, randomised controlled trial of nurse-led intensive care unit follow-up programmes versus standard care. A cost-utility analysis was conducted after 12 months' follow-up to compare the two interventions. Costs were assessed from the perspective of the UK NHS and outcomes were measured in quality-adjusted life years (QALYs) based upon responses to the EQ-5D administered at baseline, 6 and 12 months. Results: A total of 286 patients were recruited to the trial. Total mean cost was £5,789 for standard care and £7,577 for the discharge clinic. The adjusted difference in means was £2,435 [95 % confidence interval (CI) −297 to 5,566]. Mean QALYs were 0.58 for standard care and 0.60 for the discharge clinic. The adjusted mean difference was −0.003 (95 % CI −0.066 to 0.060). If society were willing to pay £20,000 per QALY then there would be a 93 % chance that standard care would be considered most efficient. Conclusions: A nurse-led intensive care unit (ICU) follow-up programme showed no evidence of being cost-effective at 12 months. Further work should focus on evidence-based development of discharge clinic services and current ICU follow-up programmes should review their practice in light of these results.
- Subjects
CRITICAL care medicine; INTENSIVE care units; CLINICAL trials; CONFIDENCE intervals; NURSING
- Publication
European Journal of Health Economics, 2014, Vol 15, Issue 3, p243
- ISSN
1618-7598
- Publication type
Article
- DOI
10.1007/s10198-013-0470-7