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Randomized Controlled Trial
. 2014 Nov;73(11):1975-82.
doi: 10.1136/annrheumdis-2013-203403. Epub 2013 Aug 27.

The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial

Mwidimi Ndosi  1 , Martyn Lewis  2 , Claire Hale  3 , Helen Quinn  4 , Sarah Ryan  5 , Paul Emery  6 , Howard Bird  7 , Jackie Hill  1
Affiliations
Randomized Controlled Trial

The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial

Mwidimi Ndosi et al. Ann Rheum Dis. 2014 Nov.

Abstract

Objective: To determine the clinical effectiveness and cost-effectiveness of nurse-led care (NLC) for people with rheumatoid arthritis (RA).

Methods: In a multicentre pragmatic randomised controlled trial, the assessment of clinical effects followed a non-inferiority design, while patient satisfaction and cost assessments followed a superiority design. Participants were 181 adults with RA randomly assigned to either NLC or rheumatologist-led care (RLC), both arms carrying out their normal practice. The primary outcome was the disease activity score (DAS28) assessed at baseline, weeks 13, 26, 39 and 52; the non-inferiority margin being DAS28 change of 0.6. Mean differences between the groups were estimated controlling for covariates following per-protocol (PP) and intention-to-treat (ITT) strategies. The economic evaluation (NHS and healthcare perspectives) estimated cost relative to change in DAS28 and quality-adjusted life-years (QALY) derived from EQ5D.

Results: Demographics and baseline characteristics of patients under NLC (n=91) were comparable to those under RLC (n=90). Overall baseline-adjusted difference in DAS28 mean change (95% CI) for RLC minus NLC was -0.31 (-0.63 to 0.02) for PP and -0.15 (-0.45 to 0.14) for ITT analyses. Mean difference in healthcare cost (RLC minus NLC) was £710 (-£352, £1773) and -£128 (-£1263, £1006) for PP and ITT analyses, respectively. NLC was more cost-effective with respect to cost and DAS28, but not in relation to QALY utility scores. In all secondary outcomes, significance was met for non-inferiority of NLC. NLC had higher 'general satisfaction' scores than RLC in week 26.

Conclusions: The results provide robust evidence to support non-inferiority of NLC in the management of RA.

Trial registration: ISRCTN29803766.

Keywords: Economic Evaluations; Health services research; Multidisciplinary team-care; Nursing; Rheumatoid Arthritis.

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Figures

Figure 1
Figure 1
Trial profile.
Figure 2
Figure 2
Summary estimates for change in disease activity score in 28 joints (DAS28) (primary outcome measure) over 12 months.
Figure 3
Figure 3
Summary of economic evaluation (healthcare perspective).
See this image and copyright information in PMC

References

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