Cost-effectiveness of bringing a nurse into an Italian genetic day clinic: a before and after study

Abstract

Background: Only a few studies explore the role of nurses in genetic counselling and genetic health care, and none of them is related to orphan diseases. In addition, few studies address the issue of finding variables that might affect the economy of a service or perform a cost-effectiveness analysis of a having genetic nurse at a unit.

Methods: A multidisciplinary panel of experts working in the hospital was set up to identify sensitive indicators and remove confounding variables. This panel evaluated efficiency and effectiveness indicators and drafted a questionnaire to estimate patient perception of the quality of the service. Data were captured from different sources, including the hospital patient database and a web-accessible platform for data collection. More than 600 clinical evaluations of 400 patients were considered, and economic parameters were studied by applying Porter's Time-Driven Activity-Based Costing methodology to evaluate costs and outcomes. Additionally, an anonymous, semi-structured, paper-and-pencil interview questionnaire was given to patients at their periodic follow-ups.

Results: The results showed an increase in the quality of patient management, more accurate data capturing, and higher quality ambulatory care. In fact, approximately 70% of the respondents reported positive changes. In addition, a parallel economic analysis explored indicators influencing economic impact, and outcomes showed positive results with the quality of outcomes improving more compared to the increase in costs.

Conclusions: The variety of evaluated issues highlighted that having a nurse in a genetic service and at day clinic activities resulted in better access, better scheduling, more satisfaction, and proved to be a cost-effective solution for patients affected by rare diseases.

Keywords: Cost effectiveness research; Genetic nurse; Health services research; Quality of care; Rare skeletal diseases.

Fig. 1

The matrix. The matrix is composed of zones marked by different colours. White – the value does not change; Red – the value is lower than the previous one; Orange – The value is lower than the previous one, but cost reduction is significant; Yellow – The value is higher, producing a similar increment on costs; Green – the value is higher than the previous one due to a significant increment in outcomes, with a low or no impact on costs

Fig. 2

A Outcome values and cost variation: Costs (applying “Time driven Activity Based Costing” method) were compared “before” and “after” and a percentage variation was reported on a scale of -3 to 3. Data obtained during the evaluation are highlighted. B Outcome values: Calculation and distribution of percentage variations for each indicator. C KPI Variation Scale: Transformation of the percentage value in a scale of -5 to 5. KPI: Key Performance Indicators

Fig. 3

The matrix result. The white X indicates the position on the evaluation matrix derived from the cross-reference of costs and outcomes