title: Nurse led versus lay educators support for those with asthma in primary care: a costing study.
abstract: BACKGROUND
  Regular review and support for asthma self-management is promoted in guidelines. A randomised controlled trial suggested that unscheduled health care usage was similar when patients were offered self management support by a lay-trainer or practice nurses.
  
  
  METHODS
  Following the RCT, a costing study was undertaken using the trial data to account for the cost of delivery of the service under both strategies and the resulting impact on unscheduled healthcare (measure of effectiveness) in this trial.
  
  
  RESULTS
  One year data (n = 418) showed that 29% (61/205) of the nurse group required unscheduled healthcare (177 events) compared with 30.5% (65/213) for lay-trainers (178 events).The training costs for the lay-trainers were greater than nurses (£36 versus £18 respectively per patient, p<0.001), however, the consultation cost for lay-trainers were lower than nurses (£6 per patient versus £24, p<0.001). If the cost of unscheduled healthcare are accounted for then the costs of nurses is £161, and £135 for lay-trainers (mean difference £25, [95% CI = -£97, £149, p = 0.681]). The total costs (delivery and unscheduled healthcare) were £202 per patient for nurses versus £178 for lay-trainers, (mean difference £24, [95%CI = -£100, £147, p = 0.707]).
  
  
  CONCLUSIONS
  There were no significant differences in the cost of training and healthcare delivery between nurse and lay trainers, and no significant difference in the cost of unscheduled health care use.
authors.affiliation: Institute for Applied Health Research/School of Health and Life Sciences Glasgow Caledonian University, Glasgow, UK. nicola.roberts@gcu.ac.uk
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Roberts
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Boyd
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Briggs
authors.forename: Ann L
authors.initials: AL
authors.lastname: Caress
authors.forename: Martyn R
authors.initials: MR
authors.lastname: Partridge
mesh_terms: D001249:Asthma / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods; D004739:England; D017048:Health Care Costs; D040441:Health Educators / Q000191:economics*; D006801:Humans; D009726:Nurses / Q000191:economics*; D010353:Patient Education as Topic / Q000191:economics* / Q000379:methods; D011320:Primary Health Care / Q000191:economics*; D012648:Self Care / Q000191:economics*; D013222:State Medicine