Economic evaluation of nurse led intermediate care versus standard care for post-acute medical patients: cost minimisation analysis of data from a randomised controlled trial.

OBJECTIVE To undertake an economic evaluation of nurse led intermediate care compared with standard hospital care for post-acute medical patients. DESIGN Cost minimisation analysis from an NHS perspective, comprising secondary care, primary care, and community care, using data from a pragmatic randomised controlled trial. SETTING Nurse led unit and acute general medical wards in large, urban, UK teaching hospital. PARTICIPANTS 238 patients. OUTCOME MEASURE Costs to acute hospital trusts and to the NHS over six months. RESULTS On an intention to treat basis, nurse led care was associated with higher costs during the initial admission period (nurse led care 7892 pounds sterling (14,970 dollars; 11,503 euros), standard care 4810 pounds sterling, difference 3082 pounds sterling (95% confidence interval 1161 pounds sterling to 5002 pounds sterling)). During the readmission period, costs were similar (nurse led care 1444 pounds sterling, standard care 1879 pounds sterling, difference -435 pounds sterling, -1406 pounds sterling to 536 pounds sterling). Total costs at six months were significantly higher (nurse led care 10,529 pounds sterling , standard care 7819 pounds sterling, difference 2710 pounds sterling, 518 pounds sterling to 4903 pounds sterling). Sensitivity analyses suggested that the trend for nurse led care to be more expensive was maintained even with substantial cost reductions, although differences were no longer significant. CONCLUSION Acute hospitals may not be cost effective settings for nurse led intermediate care. Both inpatient and total costs were significantly higher for nurse led care than for standard care of post-acute medical patients, suggesting that this model of care should not be pursued unless clinical or organisational benefits justify the increased investment.