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Cost effectiveness of nurse delivered endoscopy: findings from randomised multi-institution nurse endoscopy trial (MINuET).

Richardson G, Bloor K, Williams J, Russell I, Durai D, Cheung WY, Farrin A, Coulton S - BMJ (2009)

Bottom Line: This yields an incremental cost effectiveness ratio of pound3660 (euro3876, $5097) per QALY.Though there is uncertainty around these results, doctors are probably more cost effective than nurses for plausible values of a QALY.For plausible values of decision makers' willingness to pay for an extra QALY, endoscopy delivered by nurses is unlikely to be cost effective compared with endoscopy delivered by doctors.

View Article: PubMed Central - PubMed

Affiliation: Centre for Health Economics and Hull York Medical School (HYMS), University of York, York YO10 5DD. gar2@york.ac.uk

ABSTRACT

Objective: To compare the cost effectiveness of nurses and doctors in performing upper gastrointestinal endoscopy and flexible sigmoidoscopy.

Design: As part of a pragmatic randomised trial, the economic analysis calculated incremental cost effectiveness ratios, and generated cost effectiveness acceptability curves to address uncertainty.

Setting: 23 hospitals in the United Kingdom.

Participants: 67 doctors and 30 nurses, with a total of 1888 patients, from July 2002 to June 2003.

Intervention: Diagnostic upper gastrointestinal endoscopy and flexible sigmoidoscopy carried out by doctors or nurses.

Main outcome measure: Estimated health gains in QALYs measured with EQ-5D. Probability of cost effectiveness over a range of decision makers' willingness to pay for an additional quality adjusted life year (QALY).

Results: Although differences did not reach traditional levels of significance, patients in the doctor group gained 0.015 QALYs more than those in the nurse group, at an increased cost of about pound56 (euro59, $78) per patient. This yields an incremental cost effectiveness ratio of pound3660 (euro3876, $5097) per QALY. Though there is uncertainty around these results, doctors are probably more cost effective than nurses for plausible values of a QALY.

Conclusions: Though upper gastrointestinal endoscopies and flexible sigmoidoscopies carried out by doctors cost slightly more than those by nurses and improved health outcomes only slightly, our analysis favours endoscopies by doctors. For plausible values of decision makers' willingness to pay for an extra QALY, endoscopy delivered by nurses is unlikely to be cost effective compared with endoscopy delivered by doctors.

Trial registration: International standard RCT 82765705.

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Fig 1 Cost effectiveness acceptability curve
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fig1: Fig 1 Cost effectiveness acceptability curve

Mentions: Figure 1 shows the cost effectiveness acceptability curve for values of a QALY between zero and £50 000. Attaching no value to a QALY yields a probability of about 78% of the nurse group being cost effective, implying a chance of 78% that nurses reduced costs. The probability of nurses being cost effective, however, decreases as the value of a QALY increases and as doctors become more cost effective. At a value of £30 000 per QALY, often stated to be the borderline for the NHS, nurses have only a 13% chance of being cost effective. Indeed, for all plausible values of a QALY, doctors are more likely to be cost effective than nurses. There is, however, much uncertainty around this result; the cost effectiveness scatter in figure 2 shows the plots of incremental costs and incremental effects for doctors compared with nurses.


Cost effectiveness of nurse delivered endoscopy: findings from randomised multi-institution nurse endoscopy trial (MINuET).

Richardson G, Bloor K, Williams J, Russell I, Durai D, Cheung WY, Farrin A, Coulton S - BMJ (2009)

Fig 1 Cost effectiveness acceptability curve
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2643438&req=5

fig1: Fig 1 Cost effectiveness acceptability curve
Mentions: Figure 1 shows the cost effectiveness acceptability curve for values of a QALY between zero and £50 000. Attaching no value to a QALY yields a probability of about 78% of the nurse group being cost effective, implying a chance of 78% that nurses reduced costs. The probability of nurses being cost effective, however, decreases as the value of a QALY increases and as doctors become more cost effective. At a value of £30 000 per QALY, often stated to be the borderline for the NHS, nurses have only a 13% chance of being cost effective. Indeed, for all plausible values of a QALY, doctors are more likely to be cost effective than nurses. There is, however, much uncertainty around this result; the cost effectiveness scatter in figure 2 shows the plots of incremental costs and incremental effects for doctors compared with nurses.

Bottom Line: This yields an incremental cost effectiveness ratio of pound3660 (euro3876, $5097) per QALY.Though there is uncertainty around these results, doctors are probably more cost effective than nurses for plausible values of a QALY.For plausible values of decision makers' willingness to pay for an extra QALY, endoscopy delivered by nurses is unlikely to be cost effective compared with endoscopy delivered by doctors.

View Article: PubMed Central - PubMed

Affiliation: Centre for Health Economics and Hull York Medical School (HYMS), University of York, York YO10 5DD. gar2@york.ac.uk

ABSTRACT

Objective: To compare the cost effectiveness of nurses and doctors in performing upper gastrointestinal endoscopy and flexible sigmoidoscopy.

Design: As part of a pragmatic randomised trial, the economic analysis calculated incremental cost effectiveness ratios, and generated cost effectiveness acceptability curves to address uncertainty.

Setting: 23 hospitals in the United Kingdom.

Participants: 67 doctors and 30 nurses, with a total of 1888 patients, from July 2002 to June 2003.

Intervention: Diagnostic upper gastrointestinal endoscopy and flexible sigmoidoscopy carried out by doctors or nurses.

Main outcome measure: Estimated health gains in QALYs measured with EQ-5D. Probability of cost effectiveness over a range of decision makers' willingness to pay for an additional quality adjusted life year (QALY).

Results: Although differences did not reach traditional levels of significance, patients in the doctor group gained 0.015 QALYs more than those in the nurse group, at an increased cost of about pound56 (euro59, $78) per patient. This yields an incremental cost effectiveness ratio of pound3660 (euro3876, $5097) per QALY. Though there is uncertainty around these results, doctors are probably more cost effective than nurses for plausible values of a QALY.

Conclusions: Though upper gastrointestinal endoscopies and flexible sigmoidoscopies carried out by doctors cost slightly more than those by nurses and improved health outcomes only slightly, our analysis favours endoscopies by doctors. For plausible values of decision makers' willingness to pay for an extra QALY, endoscopy delivered by nurses is unlikely to be cost effective compared with endoscopy delivered by doctors.

Trial registration: International standard RCT 82765705.

Show MeSH