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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


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Dr Mwidimi Ndosi
Associate Professor in Nursing Rheumatology

Martyn Lewis

Claire Hale

Helen Quinn

Sarah Ryan

Paul Emery

Howard Bird

Jackie Hill


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.


Ndosi, M., Lewis, M., Hale, C., Quinn, H., Ryan, S., Emery, P., …Hill, J. (2014). The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: A multicentre randomised controlled trial. Annals of the Rheumatic Diseases, 73(11), 1975-1982.

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
Keywords cost-effectiveness, nurse-led care, rheumatoid arthritis, multicentre randomised controlled trial
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