title: Economic evaluation of nurse-led intensive care follow-up programmes compared with standard care: the PRaCTICaL trial.
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.
authors.affiliation: Health Economics Research Unit (HERU), Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Hernández
authors.forename: D
authors.initials: D
authors.lastname: Jenkinson
authors.forename: L
authors.initials: L
authors.lastname: Vale
authors.forename: B H
authors.initials: BH
authors.lastname: Cuthbertson
mesh_terms: D003266:Continuity of Patient Care / Q000191:economics; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000458:organization & administration*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D009726:Nurses / Q000191:economics / Q000458:organization & administration*; D010346:Patient Care Management / Q000191:economics / Q000458:organization & administration*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000191:economics; D006113:United Kingdom
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