Cost-effectiveness of a nurse practitioner-family physician model of care in a nursing home: controlled before and after study.
OBJECTIVE
To examine the cost-effectiveness of a nurse practitioner-family physician model of care compared with family physician-only care in a Canadian nursing home.


BACKGROUND
As demand for long-term care increases, alternative care models including nurse practitioners are being explored.


METHODS
Cost-effectiveness analysis using a controlled before-after design.


METHODS
The study included an 18-month 'before' period (2005-2006) and a 21-month 'after' time period (2007-2009). Data were abstracted from charts from 2008-2010. We calculated incremental cost-effectiveness ratios comparing the intervention (nurse practitioner-family physician model; n = 45) to internal (n = 65), external (n = 70) and combined internal/external family physician-only control groups, measured as the change in healthcare costs divided by the change in emergency department transfers/person-month. We assessed joint uncertainty around costs and effects using non-parametric bootstrapping and cost-effectiveness acceptability curves.


RESULTS
Point estimates of the incremental cost-effectiveness ratio demonstrated the nurse practitioner-family physician model dominated the internal and combined control groups (i.e. was associated with smaller increases in costs and emergency department transfers/person-month). Compared with the external control, the intervention resulted in a smaller increase in costs and larger increase in emergency department transfers. Using a willingness-to-pay threshold of $1000 CAD/emergency department transfer, the probability the intervention was cost-effective compared with the internal, external and combined control groups was 26%, 21% and 25%.


CONCLUSIONS
Due to uncertainty around the distribution of costs and effects, we were unable to make a definitive conclusion regarding the cost-effectiveness of the nurse practitioner-family physician model; however, these results suggest benefits that could be confirmed in a larger study.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Sarah
S
Lacny
Health Technology Assessment and Innovation Department, Alberta Health Services, Alberta, Canada.
Mahmood
M
Zarrabi
School of Nursing, Dalhousie University, Nova Scotia, Canada.
Ruth
R
Martin-Misener
Daphne Cockwell School of Nursing, Ryerson University, Ontario, Canada.
Faith
F
Donald
College of Pharmacy, Dalhousie University, Nova Scotia, Canada.
Ingrid
I
Sketris
College of Pharmacy, Dalhousie University, Nova Scotia, Canada.
Andrea L
AL
Murphy
School of Nursing and Department of Clinical Epidemiology and Biostatistics, McMaster University, Ontario, Canada.
Alba
A
DiCenso
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Deborah A
DA
Marshall
D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D009722:Nurse Practitioners; D009735:Nursing Homes / Q000191:economics*; D010821:Physicians, Family
cost analysis; cost-benefit analysis; costs; long-term care; nurse practitioners; nursing homes