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Economic evaluation of nurse led intermediate care versus standard care for post-acute medical patients: cost minimisation analysis of data from a randomised controlled trial

Economic evaluation of nurse led intermediate care versus standard care for post-acute medical patients: cost minimisation analysis of data from a randomised controlled trial
Economic evaluation of nurse led intermediate care versus standard care for post-acute medical patients: cost minimisation analysis of data from a randomised controlled trial
Objective: To undertake an economic evaluation of nurse led intermediate care compared with standard hospital care for post-acute medical patients.
Design: Cost minimisation analysis from an NHS perspective, comprising secondary care, primary care, and community care, using data from a pragmatic randomised controlled trial.
Setting: Nurse led unit and acute general medical wards in large, urban, UK teaching hospital.
Participants: 238 patients.
Outcome measure: Costs to acute hospital trusts and to the NHS over six months.
Results: On an intention to treat basis, nurse led care was associated with higher costs during the initial admission period (nurse led care £7892 ($14 970; 11 503), standard care £4810, difference £3082 (95% confidence interval £1161 to £5002)). During the readmission period, costs were similar (nurse led care £1444, standard care £1879, difference -£435, -£1406 to £536). Total costs at six months were significantly higher (nurse led care £10 529, standard care £7819, difference £2710, £518 to £4903). Sensitivity analyses suggested that the trend for nurse led care to be more expensive was maintained even with substantial cost reductions, although differences were no longer significant.
Conclusion: Acute hospitals may not be cost effective settings for nurse led intermediate care. Both inpatient and total costs were significantly higher for nurse led care than for standard care of post-acute medical patients, suggesting that this model of care should not be pursued unless clinical or organisational benefits justify the increased investment.
nurse-led care, standard acute care, intermediate versus acute care, nursing, post-acute medical patients, economic evaluation, cost minimisation analysis
0959-8138
699-704
Walsh, B.
5818243e-048d-4b4b-88c5-231b0e419427
Steiner, A.
5edd1b04-ec65-44e8-8f09-11553a02f0bb
Pickering, R.M.
4a828314-7ddf-4f96-abed-3407017d4c90
Ward-Basu, J.
1d1cec4e-4740-40e4-b5ed-7b162805127c
Walsh, B.
5818243e-048d-4b4b-88c5-231b0e419427
Steiner, A.
5edd1b04-ec65-44e8-8f09-11553a02f0bb
Pickering, R.M.
4a828314-7ddf-4f96-abed-3407017d4c90
Ward-Basu, J.
1d1cec4e-4740-40e4-b5ed-7b162805127c

Walsh, B., Steiner, A., Pickering, R.M. and Ward-Basu, J. (2005) Economic evaluation of nurse led intermediate care versus standard care for post-acute medical patients: cost minimisation analysis of data from a randomised controlled trial. BMJ, 330 (7493), 699-704. (doi:10.1136/bmj.38397.633588.8F).

Record type: Article

Abstract

Objective: To undertake an economic evaluation of nurse led intermediate care compared with standard hospital care for post-acute medical patients.
Design: Cost minimisation analysis from an NHS perspective, comprising secondary care, primary care, and community care, using data from a pragmatic randomised controlled trial.
Setting: Nurse led unit and acute general medical wards in large, urban, UK teaching hospital.
Participants: 238 patients.
Outcome measure: Costs to acute hospital trusts and to the NHS over six months.
Results: On an intention to treat basis, nurse led care was associated with higher costs during the initial admission period (nurse led care £7892 ($14 970; 11 503), standard care £4810, difference £3082 (95% confidence interval £1161 to £5002)). During the readmission period, costs were similar (nurse led care £1444, standard care £1879, difference -£435, -£1406 to £536). Total costs at six months were significantly higher (nurse led care £10 529, standard care £7819, difference £2710, £518 to £4903). Sensitivity analyses suggested that the trend for nurse led care to be more expensive was maintained even with substantial cost reductions, although differences were no longer significant.
Conclusion: Acute hospitals may not be cost effective settings for nurse led intermediate care. Both inpatient and total costs were significantly higher for nurse led care than for standard care of post-acute medical patients, suggesting that this model of care should not be pursued unless clinical or organisational benefits justify the increased investment.

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More information

Published date: 9 March 2005
Keywords: nurse-led care, standard acute care, intermediate versus acute care, nursing, post-acute medical patients, economic evaluation, cost minimisation analysis

Identifiers

Local EPrints ID: 24548
URI: http://eprints.soton.ac.uk/id/eprint/24548
ISSN: 0959-8138
PURE UUID: b53c12a1-1e67-4150-9da5-702dc27ef9ec
ORCID for B. Walsh: ORCID iD orcid.org/0000-0003-1008-0545

Catalogue record

Date deposited: 13 Aug 2007
Last modified: 08 Jan 2022 02:48

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Contributors

Author: B. Walsh ORCID iD
Author: A. Steiner
Author: R.M. Pickering
Author: J. Ward-Basu

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