6. Utilisation; cost outcomes.

Study	Costs based on	Cost outcomes
Campbell 2014	Staff training Setup of the interventions Cost of computer decision support software in nurse triage Clinician triage time Patient‐level quantities of resource use on other primary care contacts	Total costs: Mean 28‐day cost estimates for primary outcome contacts: Nurses ‐ £75·68 (63·09) GPs ‐ £75·21 (65·45)
Chan 2009	Medication use	Costs of medication use: Nurses – mean £35.5 (SD £48.8) Doctors – mean £71.7 (SD £ 63.1) Mean difference (adjusted baseline level): £39.6 (95% CI 24.2 to 55.1); P < 0.001
Dierick‐van Daele 2009	Direct healthcare costs Prescriptions Diagnostic procedures Referrals (in the 2 weeks after consultation) Follow‐up consultation Length of consultations Salary costs Costs outside the healthcare sector Sick leave days	Total direct healthcare costs: Nurses: €31.94 Doctors: €40.15 Mean difference (95% CI): €8.21 (3.56 to 12.85); P = 0.001 Total direct healthcare costs and productivity: Nurses: €140.40 Doctors: €145.87 Mean difference (95% CI): €1.48 (‐4.94 to 7.90); P = 0.65 Subgroup younger than 65 years: Total direct healthcare costs and productivity: Nurses: €161.57 Doctors: €170.75 Mean difference (95% CI): €9.18 (4.84 to 13.88); P < 0.001
Larsson 2014	Fixed monitoring (monitoring visit at 6 months to a rheumatology nurse, a rheumatologist; for both groups, a monitoring visit at 12 months to a rheumatologist and monitoring blood tests) Variable monitoring (additional telephone calls to a rheumatology nurse, additional telephone calls to a rheumatologist (additional rheumatologist visits, cortisone injections in addition to regular rheumatologist monitoring visits, and additional blood tests)) Rehabilitation (team rehabilitation days of care in in‐patient and out‐patient settings, individual physiotherapy treatments, occupational therapist treatments, and psychosocial treatments) Specialist consultations (orthopaedic surgeon, hand surgeon, dermatologist, and orthotist) Radiography (standard x‐ray and dual energy x‐ray absorptiometry (DEXA) scanning) Pharmacological therapy	Total annual rheumatology care per patient: Nurse‐led: €14107,70 Doctor‐led: €16274,90 Mean difference (95% CI): −2167.2 (−3757.3 to −641.7) P = 0.004
Lattimer 1998	Costs for nurse telephone consultation Recruitment Nurse salaries Indemnity insurance Co‐operative management Education programme 1 H grade – 0.25 whole time equivalent 10 days lecturer B Technical support Computers Decision support software Furniture Telephones Digital tape recorder Savings Emergency hospital admission Home visits by general practitioner Surgery attendance within 3 days	Annual direct cost:Nurse‐led service: ‐ £81,237 more than doctor‐led service Savings: Generated in reduced hospital and primary care utilisation £94,422 Net reduction in costs:with nurse‐led service £3,728 to £123,824 (determined by sensitivity analysis)
Lewis 1967	Cost per hour of the time of doctors and nurses Length of visits Total number of visits Total days of in‐patient care Unknown other costs	Total direct cost per year: Nurses ‐ $3,251 Doctors ‐ $4,199 Average cost per patient per year: Nurses ‐ $98.51 Doctors ‐ $127.24
Ndosi 2013	Resource use Healthcare professional consultations (primary and secondary care) Hospital admissions (day care, in‐patient stays, A&E visits) Investigations and treatments including over‐the‐counter medications Private out‐of‐pocket expenditures Healthcare service use Travel Medication Aids Special dietary requirements Productivity losses	NHS resources plus out‐of‐pocket expenditures: Nurses ‐ mean £1276 Doctors ‐ mean £2286 (95% CI ‐352 to 1773) P = 0.1872
Spitzer 1973a	Doctors Nurses (including nurse practitioners) Hospital and extended care Dentists Optometrists/Opticians Chiropractors Podiatrists Laboratory Diagnostic radiography Direct cash expenditures	Average cost per patient per year: Nurses ‐ $297.01 Doctors – $285.67
Venning 2000	Basic salary costs of each healthcare professional Prescriptions Tests Referrals Return consultations in the following 2 weeks	Total direct cost per consultation: Nurses – mean £18.11 (SD £33.43; range £0.66 to £297.1) Doctors – mean £20.70 (SD £33.43; range £0.78 to £300.6) Mean difference (adjusted age, sex): £2.33 (95% CI 1.62 to 6.28); P = 0.247

^aSpitzer reported an overall reduction in practice costs following the introduction of nurse practitioners, but this finding was based on observational before‐and‐after data. Data obtained from the related randomised controlled trial (reported above) did not support this finding.

A&E: accident and emergency.

CI: confidence interval.

DEXA: dual energy x‐ray absorptiometry.

GP: general practitioner.

*there may be additional data in the Campbell 2014 articles that have not been extracted