Economic evaluation of nurse-led intensive care follow-up programmes compared with standard care: the PRaCTICaL trial
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Following intensive care discharge, many patients suffer severe physical and psychological morbidity and a continuing high use of health services. Follow-up programmes have been proposed to improve the outcomes for these patients. We tested the hypothesis that nurse-led intensive care follow-up programmes are cost-effective.
A pragmatic, multicentre, randomised controlled trial of nurse-led intensive care unit follow-up programmes versus standard care. A cost-utility analysis was conducted after 12 months' follow-up to compare the two interventions. Costs were assessed from the perspective of the UK NHS and outcomes were measured in quality-adjusted life years (QALYs) based upon responses to the EQ-5D administered at baseline, 6 and 12 months.
A total of 286 patients were recruited to the trial. Total mean cost was £5,789 for standard care and £7,577 for the discharge clinic. The adjusted difference in means was £2,435 [95 % confidence interval (CI) −297 to 5,566]. Mean QALYs were 0.58 for standard care and 0.60 for the discharge clinic. The adjusted mean difference was −0.003 (95 % CI −0.066 to 0.060). If society were willing to pay £20,000 per QALY then there would be a 93 % chance that standard care would be considered most efficient.
A nurse-led intensive care unit (ICU) follow-up programme showed no evidence of being cost-effective at 12 months. Further work should focus on evidence-based development of discharge clinic services and current ICU follow-up programmes should review their practice in light of these results.
KeywordsEconomic evaluation Critical care Rehabilitation Quality of life Cost-effectiveness Cost utility analysis
The study was supported by a research grant from the Chief Scientists Office of the Scottish Government Health Directorates. The Health Services Research Unit and Health Economics Research Unit are funded by the Chief Scientists Office of the Scottish Government Health Directorates. The views expressed are those of the authors alone.
Conflict of interest
There are no conflicts of interests relating to this paper.
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