Table 2.
Characteristics of economic studies.
| Reference | Type of study/no. of participants | Country | Disease | Intervention | Outcomes | Results | Nurse training/title | Nurse activities |
|---|---|---|---|---|---|---|---|---|
| Adlbrecht et al.16 | Clinical trial – RCT (cost-effectiveness), (n = 190) | Austria | Heart failure | UC, home-based nurse care (HNC), HNC depending on NT-proBNP level (BNC) | C: death and re-hospitalization. E: cost/year survived | Costs per year survived after discharge were €19,694 for UC, €14,262 for HNC and €8784 for BNC. | Specialized heart failure nurse | Home visits, consultations, telephone follow ups, order and review blood analysis/tests, education to patients and carers |
| Arts et al.54 | Clinical trial – RCT (cost-utility), (n = 337) | The Netherlands | Diabetes | UC (care provided by physician), I (care by nurse specialist) | C: QOL, adverse events – hospital admissions, side effects from drugs, E: costs/QALY |
Intervention causes €3.61 reduction in direct costs per QALY gained, compared to UC. The ratio for overall costs shows a €20.34 increase per QALY gained (NS). | Nurse specialist | Patient care |
| Beaver et al.39 | Clinical trial – RCT (cost-minimization), (n = 374) | UK | Cancer (breast) | I (telephone follow up by CNS), UC (hospital-based consultations) | C: psychological morbidity E: resource use, difference in costs |
Telephone follow up was more expensive than UC (mean difference: €55, 95% CI: €29–€77). | Specialist nurse | Apply a structure questionnaire by phone, order test (mammography) |
| Haji Ali Afzali et al.55 | Observational (cost-effectiveness), (n = 339) | Australia | Diabetes | I (high- vs low-level involvement of Practice Nurse consultation) | C: change in blood pressure, cholesterol and HBA1c levels. E: cost/HBA1c levels |
No difference in total cost between the two models. High-level model was associated with better clinical outcomes. | Practice nurse | Education, self-management advice, monitoring clinical progress, assessing treatment |
| Iles et al.56 | Observational (only cost analysis), (n = 254) | Australia | Chronic diseases | I (Practice Nurse-led care), UC (GP-led care) | E: costs, GP visits | Net additional cost of PN-led care over GP-led care was US$129 per patient per year. | Practice nurse | Patient care |
| Jeyarajah et al.44 | Clinical trial – prospective (cost-utility), (n = 193) | UK | Cancer (colorectal) | I (cancer follow-up by nurse-led clinic) | C: recurrence of disease, survival, death E: costs/QALY |
Adjusted cost was £1914/QALY gained for lower risk tumours and £2180/QALY gained for higher-risk tumours. | Colorectal nurse specialist | Physical exam, PR exam, order tests (e.g. sigmoidoscopy), referrals, counselling |
| Koinberg et al.47 | Clinical trial – RCT (cost-minimization), (n = 264) | Sweden | Cancer (breast) | I (follow up by nurse), UC (follow up by physician) | E: resource use, costs | Nurse intervention was 20% less expensive compared to the physician follow up (£495 vs £630). | Specialist nurse | Patient education and counselling, order exams (e.g. mammography) |
| Ndosi et al.57 | Clinical trial – RCT (cost-utility), (n = 181) | UK | RA | I (nurse-led care), UC (rheumatologist-led care) | C: disease activity E: costs/QALY |
I was more cost-effective than UC with respect to cost and disease activity score, but not in relation with QALY utility scores. | Clinical Nurse specialist | Consultation (history and physical exam), prescribing medications, intra-articular or intramuscular steroid, injections, counselling |
| Paez and Allen58 | Clinical trial – RCT (cost-effectiveness), (n = 228) | US | CAD | I (lipid management by nurse), UC (lipid management by primary provider and/or cardiologist) | C: lipid levels E: cost/reduction in lipids (mg/dL) |
Annual incremental cost-effectiveness of I was US$26.03 per mg/dL and US$39.05 per percent reduction in LDL-C. | Nurse practitioner | Consultation, prescribing medications, counselling. Telephone follow up |
| Patel et al.30 | Clinical trial – RCT (cost-utility), (n = 31) | Sweden | Heart failure | I (home nurse follow-up), UC (conventional care) | C: HRQL, symptom control E: costs/QALY |
Total cost related to HF was lower in the intervention group after 12 months (p = 0.05). Costs/QALY was lower in I (NS). | Specialist nurse | Home consultations, telephone follow up, order tests (bloods), prescribing medicines |
| Postmus et al.31 | Clinical trial – RCT (cost-utility), (n = 1023) | Multicentre | Heart failure | I Basic (basic support by nurse), I Intensive (intensive support by nurse), UC (cardiologist care) | C: readmission, deaths, number of days lost because of death or HF readmission E: costs/QALY |
Basic support was found to dominate both care as usual and intensive support because it generated 0.023 and 0.004 excess QALYs while saving €77 and €1178, respectively. | Nurse specialist in HF | Hospital consultation, home visits, telephone availability, education and counselling |
| Stewart et al.33 | Observational (cost-analysis), (n = 122,000) | UK | Heart failure | Three models of HF nurse care: clinic-based service, home-based service, hybrid service | E: estimated number of patients exposed to HF services, cost and resource use of services in three models of care | Cost of applying a national programme of home-, clinic- or mix-based follow up was calculated to be £69·4, £73·1 and £72·5 million per annum, respectively. | Specialist HF nurse | Hospital consultations, home visits |
| Turner et al.35 | Clinical trial – RCT (cost-utility), (n = 1163) | UK | Heart failure/CAD | I (nurse management programme). UC (general practice care) |
C: QALY E: costs/QALY |
I generated additional QALY at an incremental cost of £13,158 per QALY compared to the UC. | Specialist nurse | Consultation, order tests, medication management, home visits |
UC: usual care; I: intervention; C: clinical; E: economic; NS: statistically non-significant; CI: confidence interval; GP: general practitioner; RA: rheumatoid arthritis; CAD: coronary artery disease; LDL-C: low-density lipoprotein cholesterol; HbA1c: glycated haemoglobin; QOL: quality of life; HRQL: health-related quality of life; QALY: quality-adjusted life-year.