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

Ndosi, Mwidimi; Lewis, Martyn; Hale, Claire; Quinn, Helen; Ryan, Sarah; Emery, Paul; Bird, Howard; Hill, Jackie

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.

• Journal Article Type: Article
• Acceptance Date: Jul 9, 2013
• Online Publication Date: Oct 5, 2014
• Publication Date: Nov 1, 2014
• Deposit Date: May 25, 2017
• Journal: Annals of the Rheumatic Diseases
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 73
• Issue: 11
• Pages: 1975-1982
• DOI: https://doi.org/10.1136/annrheumdis-2013-203403
• Keywords: cost-effectiveness, nurse-led care, rheumatoid arthritis, multicentre randomised controlled trial
• Public URL: https://uwe-repository.worktribe.com/output/808096
• Publisher URL: http://dx.doi.org/10.1136/annrheumdis-2013-203403
• Contract Date: May 25, 2017