The authors declare that they have no competing interests.
IL initiated the study, contributed to the study design, performed the data collections, data analysis, drafted the manuscript, has approved the last final submitted version and obtained funding. BF contributed to the study design, provided critical revisions of the paper in terms of important intellectual content, approved the final submitted version and obtained funding. BA and PS contributed to the study design, provided critical revisions of the paper in terms of important intellectual content, approved the final submitted version. AT initiated the study, contributed to the study design, provided critical revisions of the paper in terms of important intellectual content, approved the final submitted version. SB contributed to the study design, performed the data analysis, drafted the manuscript and has approved the last final submitted version. All authors read and approved the final manuscript.
Recommendations for rheumatology nursing management of chronic inflammatory arthritis (CIA) from European League Against Rheumatism (EULAR) states that nurses should take part in the monitoring patients’ disease and therapy in order to achieve cost savings. The aim of the study was to compare the costs of rheumatology care between a nurse-led rheumatology clinic (NLC), based on person-centred care (PCC), versus a rheumatologist-led clinic (RLC), in monitoring of patients with CIA undergoing biological therapy.
Patients with CIA undergoing biological therapy (n = 107) and a Disease Activity Score of 28 ≤ 3.2 were randomised to follow-up by either NLC or RLC. All patients met the rheumatologist at inclusion and after 12 months. In the intervention one of two annual monitoring visits in an RLC was replaced by a visit to an NLC. The primary outcome was total annual cost of rheumatology care.
A total of 97 patients completed the RCT at the 12 month follow-up. Replacing one of the two annual rheumatologist monitoring visits by a nurse-led monitoring visit, resulted in no additional contacts to the rheumatology clinic, but rather a decrease in the use of resources and a reduction of costs. The total annual rheumatology care costs including fixed monitoring, variable monitoring, rehabilitation, specialist consultations, radiography, and pharmacological therapy, generated €14107.7 per patient in the NLC compared with €16274.9 in the RCL (p = 0.004), giving a €2167.2 (13 %) lower annual cost for the NLC.
Patients with CIA and low disease activity or in remission undergoing biological therapy can be monitored with a reduced resource use and at a lower annual cost by an NLC, based on PCC with no difference in clinical outcomes. This could free resources for more intensive monitoring of patients early in the disease or patients with high disease activity.
The trial is registered as a clinical trial at the ClinicalTrials.gov (NCT01071447). Registration date: October 8, 2009.
Simard JF, Arkema EV, Sundstrom A, Geborek P, Saxne T, Baecklund E, et al. Ten years with biologics: to whom do data on effectiveness and safety apply? Rheumatology (Oxford). 2011;50:204–13. CrossRef
Nam JL, Ramiro S, Gaujoux-Viala C, Takase K, Leon-Garcia M, Emery P, et al. Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis. 2014;73:516–28. CrossRefPubMed
Nolte E, McKee M. Caring for people with chronic conditions - A health system perspective, European Observatory on Health System and Policies Series. NewYork: WHO; 2008.
Primdahl J, Sorensen J, Horn HC, Petersen R, Horslev-Petersen K. Shared care or nursing consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis outpatients with low disease activity--patient outcomes from a 2-year, randomised controlled trial. Ann Rheum Dis. 2014;73:357–64. CrossRefPubMed
Sorensen J, Primdahl J, Horn H, Horslev-Petersen K. Shared care or nurse consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis (RA) outpatients with stable low disease-activity RA: cost-effectiveness based on a 2-year randomized trial. Scand J Rheumatol. 2015;44:13–21. CrossRefPubMed
Kalkan A, Hallert E, Bernfort L, Husberg M, Carlsson P. Costs of rheumatoid arthritis during the period 1990–2010: a register-based cost-of-illness study in Sweden. Rheumatology (Oxford). 2014;53:153–60. CrossRef
Ovretveit J, Keller C, Forsberg HH, Essen A, Lindblad S, Brommels M. Continuous innovation: developing and using a clinical database with new technology for patient-centred care--the case of the Swedish quality register for arthritis. Int J Qual Health Care. 2013;25(2):118–24. doi: 10.1093/intqhc/mzt002. CrossRefPubMed
WMA. World Medical Association declaration of Helsinki. Ethical principles for medical research involving human subjects. 2013.
van den Hout WB, Tijhuis GJ, Hazes JM, Breedveld FC, Vliet Vlieland TP. Cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis: a randomised comparison of clinical nurse specialist care, inpatient team care, and day patient team care. Ann Rheum Dis. 2003;62:308–15. PubMedCentralCrossRefPubMed
Jakimowicz S, Stirling C, Duddle M. An investigation of factors that impact patients’ subjective experience of nurse-led clinics: a qualitative systematic review. J Clin Nurs. 2015;23:19–33. CrossRef
Hansson E, Ekman I, Swedberg K, Wolf A, Dudas K, Ehlers L, et al. Person-centred care for patients with chronic heart failure - a cost-utility analysis. Eur J Cardiovasc Nurs. 2015. doi: 10.1177/1474515114567035 [Epub ahead on print].
Ulin K, Olsson LE, Wolf A, Ekman I. Person-centred care - An approach that improves the discharge process. Eur J Cardiovasc Nurs. 2015. doi: 10.1177/1474515115569945 [Epub ahead on print].
McBain H, Shipley M, Olaleye A, Moore S, Newman S. A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis on methotrexate: a randomised controlled trial. Ann Rheum Dis. 2015. doi: 10.1136/annrheumdis-2015-207768.
Schabert VF, Watson C, Joseph GJ, Iversen P, Burudpakdee C, Harrison DJ. Costs of tumor necrosis factor blockers per treated patient using real-world drug data in a managed care population. J Manag Care Pharm. 2013;19:621–30. PubMed
Bykerk VP, Keystone EC, Kuriya B, Larche M, Thorne JC, Haraoui B. Achieving remission in clinical practice: lessons from clinical trial data. Clin Exp Rheumatol. 2013;31:621–32. PubMed
Coates LC, Navarro-Coy N, Brown SR, Brown S, McParland L, Collier H, et al. The TICOPA protocol (TIght COntrol of Psoriatic Arthritis): a randomised controlled trial to compare intensive management versus standard care in early psoriatic arthritis. BMC Musculoskelet Disord. 2013;14:101. PubMedCentralCrossRefPubMed
Daul P, Grisanti J. Monitoring response to therapy in rheumatoid arthritis - perspectives from the clinic. Bull NYU Hosp Jt Dis. 2009;67:236–42. PubMed
van Eijk-Hustings Y, Ndosi M, Buss B, Fayet F, Moretti A, Ryan S, et al. Dissemination and evaluation of the European league against rheumatism recommendations for the role of the nurse in the management of chronic inflammatory arthritis: results of a multinational survey among nurses, rheumatologists and patients. Rheumatology (Oxford). 2014;53:1491–6. CrossRef
- A nurse-led rheumatology clinic versus rheumatologist-led clinic in monitoring of patients with chronic inflammatory arthritis undergoing biological therapy: a cost comparison study in a randomised controlled trial
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