title: A nurse-led rheumatology clinic versus rheumatologist-led clinic in monitoring of patients with chronic inflammatory arthritis undergoing biological therapy: a cost comparison study in a randomised controlled trial.
abstract: BACKGROUND
  Recommendations for rheumatology nursing management of chronic inflammatory arthritis (CIA) from European League Against Rheumatism (EULAR) states that nurses should take part in the monitoring patients' disease and therapy in order to achieve cost savings. The aim of the study was to compare the costs of rheumatology care between a nurse-led rheumatology clinic (NLC), based on person-centred care (PCC), versus a rheumatologist-led clinic (RLC), in monitoring of patients with CIA undergoing biological therapy.
  
  
  METHODS
  Patients with CIA undergoing biological therapy (n = 107) and a Disease Activity Score of 28 ≤ 3.2 were randomised to follow-up by either NLC or RLC. All patients met the rheumatologist at inclusion and after 12 months. In the intervention one of two annual monitoring visits in an RLC was replaced by a visit to an NLC. The primary outcome was total annual cost of rheumatology care.
  
  
  RESULTS
  A total of 97 patients completed the RCT at the 12 month follow-up. Replacing one of the two annual rheumatologist monitoring visits by a nurse-led monitoring visit, resulted in no additional contacts to the rheumatology clinic, but rather a decrease in the use of resources and a reduction of costs. The total annual rheumatology care costs including fixed monitoring, variable monitoring, rehabilitation, specialist consultations, radiography, and pharmacological therapy, generated € 14107.7 per patient in the NLC compared with € 16274.9 in the RCL (p = 0.004), giving a € 2167.2 (13 %) lower annual cost for the NLC.
  
  
  CONCLUSIONS
  Patients with CIA and low disease activity or in remission undergoing biological therapy can be monitored with a reduced resource use and at a lower annual cost by an NLC, based on PCC with no difference in clinical outcomes. This could free resources for more intensive monitoring of patients early in the disease or patients with high disease activity.
  
  
  BACKGROUND
  The trial is registered as a clinical trial at the ClinicalTrials.gov (NCT01071447). Registration date: October 8, 2009.
authors.affiliation: School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden. Ingrid.larsson@hh.se.|Spenshult Research and Development Centre, Halmstad, Sweden. Ingrid.larsson@hh.se.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Larsson
authors.affiliation: School of Health and Welfare, Jönköping University, Jönköping, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Fridlund
authors.affiliation: School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden.
authors.forename: Barbro
authors.initials: B
authors.lastname: Arvidsson
authors.affiliation: Capio Movement Hospital, Halmstad, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Teleman
authors.affiliation: School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden.
authors.forename: Petra
authors.initials: P
authors.lastname: Svedberg
authors.affiliation: School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden.|Spenshult Research and Development Centre, Halmstad, Sweden.|Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bergman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D001691:Biological Therapy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis / Q000379:methods*; D016903:Drug Monitoring / Q000191:economics / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000191:economics*; D010044:Outpatient Clinics, Hospital / Q000191:economics; D010820:Physicians / Q000191:economics*; D011446:Prospective Studies; D012219:Rheumatology / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult