title: Cost-effectiveness of shared medical appointments for neuromuscular patients.
abstract: OBJECTIVE
  To assess whether shared medical appointments (SMAs) for neuromuscular patients represent a way of using clinicians' time efficiently without compromising quality of care for patients.
  
  
  METHODS
  Patients with a chronic neuromuscular disease (NMD) (n = 272) were randomly allocated to either an SMA or a regular individual annual appointment and followed up for a period of 6 months. Data on resource utilization and quality of life (EQ-5D) were collected prospectively, using a health care perspective. Incremental costs and changes in quality-adjusted life-years (QALYs) were computed using a probabilistic decision model. Factors critical to the incremental cost-effectiveness of SMAs were explored in sensitivity analyses.
  
  
  RESULTS
  No substantial differences between SMAs and individual visits in terms of costs per QALY were found (incremental cost-effectiveness ratio €-960.00; 95% confidence interval €-34,600.00, €+36,800.00). Sensitivity analyses showed that the cost-effectiveness ratio was particularly sensitive to SMA group size and proportion of patients seeing their treating neurologist.
  
  
  CONCLUSIONS
  Cost-effectiveness of SMAs did not show a significant difference vs that of individual appointments based on data from our randomized controlled trial. On the other hand, we were able to show that a minimum of 6 patients per SMA and 75% of patients attending their treating neurologist are specific conditions under which SMAs qualify as a cost-effective alternative. This implies that SMAs may be a means to increase productivity of the physician without compromising quality of care.
  
  
  METHODS
  This study provides Class III evidence that SMAs are not significantly more cost-effective than individual appointments for patients with NMDs. The study lacks the precision to exclude important differences in cost-effectiveness between SMAs and individual appointments.
authors.affiliation: From the Departments of Neurology (F.M.S., G.D., B.G.M.v.E.) and Health Evidence (H.J.G., G.J.v.d.W.), Radboud University Medical Centre, Nijmegen; and the Departments of Neurology and Neurosurgery (G.D.), University of Groningen, University Medical Center Groningen, the Netherlands. femke.seesing@radboudumc.nl.
authors.forename: Femke M
authors.initials: FM
authors.lastname: Seesing
authors.affiliation: From the Departments of Neurology (F.M.S., G.D., B.G.M.v.E.) and Health Evidence (H.J.G., G.J.v.d.W.), Radboud University Medical Centre, Nijmegen; and the Departments of Neurology and Neurosurgery (G.D.), University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Groenewoud
authors.affiliation: From the Departments of Neurology (F.M.S., G.D., B.G.M.v.E.) and Health Evidence (H.J.G., G.J.v.d.W.), Radboud University Medical Centre, Nijmegen; and the Departments of Neurology and Neurosurgery (G.D.), University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Gea
authors.initials: G
authors.lastname: Drost
authors.affiliation: From the Departments of Neurology (F.M.S., G.D., B.G.M.v.E.) and Health Evidence (H.J.G., G.J.v.d.W.), Radboud University Medical Centre, Nijmegen; and the Departments of Neurology and Neurosurgery (G.D.), University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Baziel G M
authors.initials: BG
authors.lastname: van Engelen
authors.affiliation: From the Departments of Neurology (F.M.S., G.D., B.G.M.v.E.) and Health Evidence (H.J.G., G.J.v.d.W.), Radboud University Medical Centre, Nijmegen; and the Departments of Neurology and Neurosurgery (G.D.), University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: van der Wilt
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000191:economics* / Q000628:therapy; D011787:Quality of Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years