Cost-effectiveness of a nurse-led case management intervention in general medical outpatients compared with usual care: an economic evaluation alongside a randomized controlled trial.
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.


CONCLUSIONS
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.
Latour
Corine H M
CH
Psychiatric Consultation and Liaison Service, VU University Medical Center, Amsterdam, The Netherlands. chm.latour@vumc.nl
Bosmans
Judith E
JE
van Tulder
Maurits W
MW
de Vos
Rien
R
Huyse
Frits J
FJ
de Jonge
Peter
P
van Gemert
Liesbeth A M
LA
Stalman
Wim A B
WA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000191:economics; D004470:Economics, Medical; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009720:Nurse Clinicians / Q000191:economics*; D010348:Patient Care Team / Q000191:economics / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000191:economics*; D010359:Patient Readmission / Q000191:economics; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D013038:Specialization; D014600:Utilization Review / Q000706:statistics & numerical data