ECONOMIC EVALUATION OF NURSE-LED SERVICES IN THE ACUTE CARE SETTING-A SYSTEMATIC REVIEW

Purpose:

Nurses in Singapore are now taking on more roles typically done by doctors. Nonetheless, roles and job scopes of advanced practice nurses (APN) and specialty care nurses (SCN) in Singapore tend to vary across departments, clinical disciplines and institutions. Although the role of APNs and SCN should be reflective of local health care needs, it is useful to gather and appraise the evidence on nurse-led services/programs’ impact on patients’ outcomes and health care costs.

This systematic review aimed to evaluate the cost-effectiveness of nurse-led services in the acute-care setting.

 

Population	Patients who access inpatient and out-patient services in the acute care settings.
Intervention	Nurse-led services based in the acute-care.
Comparison	Services/Programs led by medical doctors
Outcomes	Healthcare costs incurred

Method:

A systematic review was performed using the databases of MEDLINE(OVID), CINAHL, EMBASE, PUBMED, Centre for Reviews and Dissemination and The Cochrane Library with  the following terms:

(nurse-led) or (nursing-led) or (advanced practice nursing) or (advanced practice nurse) or (specialist nurse) or (clinical nurse specialist) AND (acute care) or (hospital) or (inpatient) or (tertiary care) or (acute clinic) or (specialist clinic). The search was done in June 2011. Studies were limited to those published in the last ten years.

Papers were assessed by two independent reviewers using standardized critical appraisal tools. Any disagreements were resolved through discussion with a third reviewer.

Result:

Only 6 cost-effectiveness and 1 cost-minimization studies were found. A wide range of medical conditions (rheumatology, respiratory, heart failure, diabetes, internal medicine) were involved. 3 studies reported that nurse-led services provided equivalent care but was more costly; 2 studies found that such services were cost-effective at US$4020/QALY (blood pressure lowering); US$19950/QALY(lipid lowering) and Euro17543/QALY; Euro15169/health utility index . Only 1 study was of good quality while 2 suffer from major methodological flaws.

Conclusion:

Although cut-off point for what constitutes cost-effectiveness varies across societies, there was limited evidence that nurse-led services in the acute care setting are cost-saving or cost-effective. Henceforth, to ensure sustainability, it is pertinent that cost-effectiveness analysis forms part of the evaluation of nurse-led programs/services.