Charline Mourgues1, Marie Blanquet2, Laurent Gerbaud2, Martin Soubrier3, Maxime Dougados4. 1. Délégation à la recherche clinique et à l'innovation, centre hospitalier universitaire de Clermont-Ferrand, 7, place Henri-Dunant, 63058 Clermont-Ferrand cedex 1, France. Electronic address: C_mourgues@chu-clermontferrand.fr. 2. Service de santé publique, CHU de Clermont-Ferrand, 7, place Henri-Dunant, 63058 Clermont-Ferrand cedex 1, France; EA 4681, PEPRADE (Périnatalité, grossesse, environnement, PRAtiques médicales et DEveloppement), Clermont université, université d'Auvergne, 63058 Clermont-Ferrand, France. 3. Service de rhumatologie, CHU de Clermont-Ferrand, 58, rue Montalembert, 63058 Clermont-Ferrand cedex 1, France. 4. Service rhumatologie B, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Abstract
OBJECTIVES: Rheumatoid arthritis (RA) cause major functional, psychological, social and occupational repercussions for patients and has important economic consequences for society. The principal objective of this work was to determine the economic pertinence of a staff nurse specialised in preventive management for these patients. METHODS: The COMEDRA multicentre randomised controlled clinical trial, conducted from March 2011 to June 2012, showed the effectiveness of a nurse-led programme dedicated to the management of comorbidities trough the promotion of 11 preventive procedures. A cost-benefit analysis, from a societal perspective and based on direct medical cost, was conducted to assess the equivalence of the cost of the nurse-led programme and the cost of the additional preventive procedures performed, engendered by the programme. The programme was considered effective if its cost was less than or equal to the costs of the additional preventive procedures. The costs were calculated from the approved health insurance charges. From the total costs induced, a contributive share was measured, corresponding to the ratio of the total costs of each type of procedure to the overall total cost. RESULTS: The cost of the intervention was assessed at €16,804.2. This intervention contributed to the performance of 747 additional preventive procedures, at a cost of €30,184.8. This intervention with these patients is financially balanced when at least 37 patients follow the recommendations for every preventive procedure. CONCLUSIONS: From the hospital's perspective and from both a medical and economic point of view, a nurse-led programme to manage the comorbidities of RA is useful.
RCT Entities:
OBJECTIVES:Rheumatoid arthritis (RA) cause major functional, psychological, social and occupational repercussions for patients and has important economic consequences for society. The principal objective of this work was to determine the economic pertinence of a staff nurse specialised in preventive management for these patients. METHODS: The COMEDRA multicentre randomised controlled clinical trial, conducted from March 2011 to June 2012, showed the effectiveness of a nurse-led programme dedicated to the management of comorbidities trough the promotion of 11 preventive procedures. A cost-benefit analysis, from a societal perspective and based on direct medical cost, was conducted to assess the equivalence of the cost of the nurse-led programme and the cost of the additional preventive procedures performed, engendered by the programme. The programme was considered effective if its cost was less than or equal to the costs of the additional preventive procedures. The costs were calculated from the approved health insurance charges. From the total costs induced, a contributive share was measured, corresponding to the ratio of the total costs of each type of procedure to the overall total cost. RESULTS: The cost of the intervention was assessed at €16,804.2. This intervention contributed to the performance of 747 additional preventive procedures, at a cost of €30,184.8. This intervention with these patients is financially balanced when at least 37 patients follow the recommendations for every preventive procedure. CONCLUSIONS: From the hospital's perspective and from both a medical and economic point of view, a nurse-led programme to manage the comorbidities of RA is useful.