Cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis: a randomised comparison of clinical nurse specialist care, inpatient team care, and day patient team care.
OBJECTIVE
To assess the relative cost effectiveness of clinical nurse specialist care, inpatient team care, and day patient team care.


METHODS
Incremental cost effectiveness analysis and cost utility analysis, alongside a prospective randomised controlled trial with two year follow up. Included were patients with rheumatoid arthritis (RA) with increasing difficulty in performing activities of daily living over the previous six weeks. Quality of life and utility were assessed by the Rheumatoid Arthritis Quality of Life questionnaire, the Short Form-6D, a transformed rating scale, and the time tradeoff. A cost-price analysis was conducted to estimate the costs of inpatient and day patient hospitalisations. Other healthcare and non-healthcare costs were estimated from cost questionnaires.


RESULTS
210 patients with RA (75% female, median age 59 years) were included. Aggregated over the two year follow up period, no significant differences were found on the quality of life and utility instruments. The costs of the initial treatment were estimated at euro 200 for clinical nurse specialist care, euro 5000 for inpatient team care, and euro 4100 for day patient team care. Other healthcare costs and non-healthcare costs were not significantly different. The total societal costs did not differ significantly between inpatients and day patients, but were significantly lower for the clinical nurse specialist patients by at least euro 5400.


CONCLUSIONS
Compared with inpatient and day patient team care, clinical nurse specialist care was shown to provide equivalent quality of life and utility, at lower costs. Therefore, for patients with health conditions that allow for any of the three types of care, the preferred treatment from a health-economic perspective is the care provided by the clinical nurse specialist.
van den Hout
W B
WB
Department of Medical Decision Making, Leiden University Medical Centre, The Netherlands. W.B.van_den_Hout@LUMC.NL
Tijhuis
G J
GJ
Hazes
J M W
JM
Breedveld
F C
FC
Vliet Vlieland
T P M
TP
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000191:economics* / Q000451:nursing / Q000628:therapy; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003631:Day Care, Medical / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009720:Nurse Clinicians / Q000191:economics*; D010348:Patient Care Team / Q000191:economics; D011446:Prospective Studies; D011788:Quality of Life