Economic evaluation of nurse-led intensive care follow-up programmes compared with standard care: the PRaCTICaL trial.

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  • Author(s): Hernández RA;Hernández RA; Jenkinson D; Vale L; Cuthbertson BH
  • Source:
    The European journal of health economics : HEPAC : health economics in prevention and care [Eur J Health Econ] 2014 Apr; Vol. 15 (3), pp. 243-52. Date of Electronic Publication: 2013 Mar 28.
  • Publication Type:
    Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Springer-Verlag Country of Publication: Germany NLM ID: 101134867 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1618-7601 (Electronic) Linking ISSN: 16187598 NLM ISO Abbreviation: Eur J Health Econ Subsets: MEDLINE
    • Publication Information:
      Original Publication: Berlin : Springer-Verlag, c2001-
    • Subject Terms:
      Critical Care/*organization & administration ; Nurses/*organization & administration ; Patient Care Management/*organization & administration; Continuity of Patient Care/economics ; Cost-Benefit Analysis ; Critical Care/economics ; Health Services/statistics & numerical data ; Humans ; Nurses/economics ; Patient Care Management/economics ; Quality of Life ; Quality-Adjusted Life Years ; State Medicine/economics ; United Kingdom
    • 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.
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    • Grant Information:
      HERU1 United Kingdom CSO_ Chief Scientist Office; HSRU1 United Kingdom CSO_ Chief Scientist Office; MR/K02325X/1 United Kingdom MRC_ Medical Research Council
    • Publication Date:
      Date Created: 20130329 Date Completed: 20141201 Latest Revision: 20220129
    • Publication Date:
      20250114
    • Accession Number:
      10.1007/s10198-013-0470-7
    • Accession Number:
      23535984