TY - JOUR
T1 - Cost-effectiveness of a nurse-led case management intervention in general medical outpatients compared with usual care
T2 - an economic evaluation alongside a randomized controlled trial
AU - Latour, Corine H M
AU - Bosmans, Judith E
AU - van Tulder, Maurits W
AU - de Vos, Rien
AU - Huyse, Frits J
AU - de Jonge, Peter
AU - van Gemert, Liesbeth A M
AU - Stalman, Wim A B
PY - 2007/3
Y1 - 2007/3
N2 - OBJECTIVE: The objective of this study was to evaluate the cost-effectiveness of a nurse-led, home-based, case-management intervention (NHI) after hospital discharge in addition to usual care.METHODS: Economic evaluation alongside a randomized controlled trial after being discharged home with 24 weeks of follow-up. Patients discharged to their home from a general hospital were randomly assigned to NHI or usual care. Clinical outcomes were frequency of emergency readmissions, quality of life, and psychological functioning. Direct costs were measured by means of cost diaries kept by the patients and information obtained from the patients' pharmacists.RESULTS: A total of 208 patients were randomized, 61 patients dropped out, and 26 had incomplete data, leaving a total of 121 patients included in the final analysis. There were no statistically significant differences in emergency readmissions, quality of life, and psychological functioning. There was a substantial difference in total costs between the NHI group and the control group (4286 Euro; 95% CI, -41; 8026), but this difference was not statistically significant.CONCLUSION: NHI is not a cost-effective intervention. We do not recommend the implementation of this intervention in populations that do not consist of severely vulnerable and complex patients. Future studies should include complexity assessment on inclusion and evaluate the effectiveness and cost-effectiveness of this intervention in patients with more complex profiles.
AB - OBJECTIVE: The objective of this study was to evaluate the cost-effectiveness of a nurse-led, home-based, case-management intervention (NHI) after hospital discharge in addition to usual care.METHODS: Economic evaluation alongside a randomized controlled trial after being discharged home with 24 weeks of follow-up. Patients discharged to their home from a general hospital were randomly assigned to NHI or usual care. Clinical outcomes were frequency of emergency readmissions, quality of life, and psychological functioning. Direct costs were measured by means of cost diaries kept by the patients and information obtained from the patients' pharmacists.RESULTS: A total of 208 patients were randomized, 61 patients dropped out, and 26 had incomplete data, leaving a total of 121 patients included in the final analysis. There were no statistically significant differences in emergency readmissions, quality of life, and psychological functioning. There was a substantial difference in total costs between the NHI group and the control group (4286 Euro; 95% CI, -41; 8026), but this difference was not statistically significant.CONCLUSION: NHI is not a cost-effective intervention. We do not recommend the implementation of this intervention in populations that do not consist of severely vulnerable and complex patients. Future studies should include complexity assessment on inclusion and evaluate the effectiveness and cost-effectiveness of this intervention in patients with more complex profiles.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Case Management/economics
KW - Cost-Benefit Analysis/economics
KW - Economics, Medical
KW - Emergency Service, Hospital/economics
KW - Female
KW - Home Care Services/economics
KW - Humans
KW - Male
KW - Middle Aged
KW - Netherlands
KW - Nurse Clinicians/economics
KW - Patient Care Team/economics
KW - Patient Discharge/economics
KW - Patient Readmission/economics
KW - Referral and Consultation/economics
KW - Specialization
KW - Utilization Review/statistics & numerical data
U2 - 10.1016/j.jpsychores.2006.10.016
DO - 10.1016/j.jpsychores.2006.10.016
M3 - Article
C2 - 17324688
SN - 0022-3999
VL - 62
SP - 363
EP - 370
JO - Journal of Psychosomatic Research
JF - Journal of Psychosomatic Research
IS - 3
ER -