Cost-Effectiveness of Nurse-Delivered Endoscopy: Findings from a Randomised Multi-Institution Nurse Endoscopy Trial (MINuET)

TY - JOUR

T1 - Cost-Effectiveness of Nurse-Delivered Endoscopy

T2 - Findings from a Randomised Multi-Institution Nurse Endoscopy Trial (MINuET)

AU - Richardson, Gerry

AU - Bloor, Karen

AU - Williams, John

AU - Russell, Ian

AU - Durai, Dharmaraj

AU - Cheung, Wai Yee

AU - Farrin, Amanda

AU - Coulton, Simon

N1 - Correction: In the full version of this paper by Gerry Richardson and colleagues on bmj.com (BMJ 2009;338:b270, doi:10.1136/bmj.b270), we omitted to take in the authors’ corrections to figure 2. The axis labels should be switched: the y axis should be labelled "Cost difference (£)" and the x axis should be labelled "Effect difference (£)."

PY - 2009/2/10

Y1 - 2009/2/10

N2 - 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 56 pound ((sic)59, $78) per patient. This yields an incremental cost effectiveness ratio of 3660 pound ((sic)3876, $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

AB - 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 56 pound ((sic)59, $78) per patient. This yields an incremental cost effectiveness ratio of 3660 pound ((sic)3876, $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

UR - http://www.scopus.com/inward/record.url?scp=61449094857&partnerID=8YFLogxK

U2 - 10.1136/bmj.b270

DO - 10.1136/bmj.b270

M3 - Article

SN - 0959-8138

VL - 338

SP - 1

EP - 9

JO - BMJ

JF - BMJ

M1 - b270

ER -