Background
Methods
Assessment of health outcome
Quantifying use of resources
Costs
Resource item†
| Cost | Basis of estimate |
---|---|---|
Primary care
| ||
General Practitioner (GP) surgery appointments | £36.00 | An 11.7 minute consultation |
General Practitioner (GP) home visits | £58.00 | A 23.4 minute visit |
Practice nurse (PN) surgery appointments | £11.00 | A consultation |
Community/district nurse (CN) visits | £26.00 | A home visit |
Hospital-based care
| ||
*Acute hospital bed days | £213.20 | A bed day of inpatient rehabilitation for an elderly person (£205 inflated by 1.04) |
Day admissions | £138.00 | A day care service attendance for an elderly person |
Accident & Emergency (A&E) attendances | £111.00 | An A&E treatment |
Minor Injury Unit (MIU) attendances | £35.00 | An attendance at a non 24-hour A&E department/Casualty department |
Outpatient consultant appointments | £55.00 | A first-attendance appointment |
£71.00 | A follow-up attendance appointment | |
^Parkinson’s Disease specialist nurse (PDNS) appointments | £15.00 | A 15 minute consultation (using ‘Nurse advanced [includes lead specialist, clinical nurse specialist, senior specialist]) |
^Parkinson’s Disease specialist nurse (PDNS) visits | £16.66 | A 25 minute home visit (using ‘Nurse advanced [includes lead specialist, clinical nurse specialist, senior specialist]) at £40/hour |
Social care
| ||
Social worker/community care manager assessments | £414.00 | An hour of face-to-face contact = £138 Average length of contact (from DCC info provided to QAQoL) = 3hours |
Hours of home care (per hour) | £19.30 | One hour of local authority organized home care |
Hours of day care (per hour) | £11.66 | A session = £35 |
Estimated 3 hours per session | ||
Days of residential care (per day) | £136.86 | Local authority care package for a short-term resident week = £958 |
Days of nursing care (per day) | £93.71 | Private care package cost for a short-term resident week = £656 |
Data analysis and statistical methods
Results
Available (N=93) | Missing (N=37) | |
---|---|---|
Age in years mean (SD) | 71.0 (8.8) | 71.1 (7.7) |
Male (%) | 48 (52%) | 26 (70%) |
Years since diagnosis of PD mean (SD) | 8.8 (6.5) | 8.3 (6.2) |
Hoehn and Yahr stage Mean (SD) | 2.5 (0.9) | 2.6 (0.9) |
Living arrangements n (%) | ||
Alone | 21 (23%) | 12 (32%) |
With partner | 68 (73%) | 24 (65%) |
With family/friends | 2 (2%) | 1 (3%) |
Residential home | 2 (2%) | 0 (0%) |
Parkinson’s medication n (%) | ||
LCT | 88 (95%) | 36 (97%) |
DRA | 46 (49%) | 18 (49%) |
MOAI | 16 (17%) | 6 (16%) |
Co-morbidity n (%) | ||
Orthopaedic | 31 (33%) | 15 (41%) |
Cardiac | 30 (32%) | 16 (43%) |
EQ-5D mean (SD) | 0.67 (0.23) | 0.68 (0.25) |
Total healthcare costs in previous 10 weeks (£) mean (SD)+ | 142 (227) | 768 (481) |
Exercise intervention costs
Health and social care service resource use
Intervention (n=48) | Control (n=45) | Effect size (95% CI), P-value | |
---|---|---|---|
Parkinson’s medication
| |||
LCT n/N (%) | 42/45 (91%) | 38/41 (93%) | Relative risk −0.96 (0.86to 1.08), 0.524 |
GA n/N (%) | 1/46 (2%) | 3/42 (7%) | Relative risk 0.32 (0.03 to 2.96), 0.315 |
AC n/N (%) | 0/47 (0%) | 1/44 (2%) | Not calculable |
CTI n/N (%) | 1/47 (2%) | 3/42 (7%) | Relative risk 0.31 (0.03 to 2.89), 0.306 |
DRA n/N (%) | 19/45 (42%) | 17/42 (40%) | Relative risk 1.04 (0.63 to 1.72), 0.869 |
MOBI n/N (%) | 4/46 (9%) | 5/43 (12%) | Relative risk 0.75 (0.21 to 2.60), 0.648 |
Primary care contacts
| |||
GP appointments, mean (SD) | 2.19 (3.05) | 1.96 (2.58) | Rate ratio 1.12 (0.84 to 1.48), 0.438 |
GP home visits, mean (SD) | 0.08 (0.28) | 0.09 (0.29) | Rate ratio 0.92 (0.23 to 3.66), 0.902 |
PN appointments., mean (SD) | 0.83 (1.17) | 0.84 (1.42) | Rate ratio 0.99 (0.63 to 1.56), 0.984 |
CN home visits, mean (SD) | 0.04 (0.19) | 0.23 (0.99) | Rate ratio 0.15 (0.02 to 1.28), 0.084 |
Acute healthcare contacts
| |||
Hospitalisations, mean (SD) | 0.06 (0.24) | 0.33 (0.74) | Rate ratio 0.19 (0.05 to 0.65), 0.008 |
Inpatient bed days, mean (SD)* | 0.50 (3.18) | 1.51 (6.30) | Mean difference −1.01 (−3.04 to 1.02), 0.326 |
Day cases, mean (SD) | 0.02 (0.14) | 0.11 (0.38) | Rate ratio 0.19 (0.02 to 1.60), 0.126 |
A&E attendances, mean (SD) | 0.10 (0.37) | 0.16 (0.56) | Rate ratio 0.67 (0.21 to 2.11), 0.493 |
Outpatient consultant | |||
Appointments, mean (SD) | 2.25 (2.14) | 2.69 (2.79) | Rate ratio 0.84 (0.65 to 1.08), 0.178 |
PDNS appointments, mean (SD) | 0 (0) | 0.02 (0.15) | Not calculable |
PDNS home visits, mean (SD) | 0 (0) | 0 (0) | Not calculable |
Social care contacts
| |||
Social/community care assessments | 0.17 (0.52) | 0.04 (0.21) | Rate ratio 3.74 (0.80 to 17.63), 0.095 |
Home care received, n/N (%) | 2/45 (4%) | 1/48 (2%) | Relative risk 1.88 (0.17 to 19.97), 0.60 |
Hours of home care, mean (SD) † | 9.15 (45.9) | 2.00 (13.42) | Mean difference 7.14 (−7.00 to 21.29), 0.318 |
Day care received, n/N (%) | 1/47 (2%) | 0/45 (0%) | Not calculable |
Hours of day care, mean (SD)** | 0.42 (2.91) | 0 (0) | Mean difference 0.42 (−0.44 to 1.29), 0.331 |
Residential care received, n/N (%) | 1/44 (2%) | 0/48 (0%) | Not calculable |
Hours of residential care, mean (SD) | 0 (0) | 0.44 (2.98) | Mean difference −0.44 (1.30 to 0.41), 0.304 |
Nursing care relieved, n/N (%) | 1/44 (2%) 0 (0) | 0/48 (0%) 0.44 (2.98) | Not calculable |
Mean difference −0.44 (1.30 to 0.41), 0.304 | |||
Hours of nursing care, mean†† |
Health and social care service costs
Intervention Mean (SD), median N=48 | Control Mean (SD), median N=45 | Mean difference (95% CI) P-value | |
---|---|---|---|
Parkinson’s medications (£)
| |||
Mean (SD) | 836 (994), 579 | 707 (812), 331 | 129 (−490 to 233), 0.50 |
Acute healthcare (£)
| |||
Inpatient bed days, mean (SD) | 107 (678), 0 | 322 (1339), 0 | −215 (−643 to 212), 0.324 |
Day case, mean (SD) | 3 (20), 0 | 15 (53), 0 | −12 (−30 to 5), 0.156 |
A&E attendances, mean (SD) | 12 (41), 0 | 17 (62), 0 | −6 (−28 to 17), 0.616 |
Outpatient consultant appointments, mean (SD) | 142 (19), 126 | 169 (26), 162 | −28 (−92 to 36), 0.398 |
PDNS appointments, mean (SD) | 0 (0), 0 | 1 (2), 0 | 1 (−1 to 1), 0.321 |
PDNS home visits, mean (SD) | 0 (0), 0 | 0 (0), 0 | Not calculable |
Total acute healthcare, mean (SD) | 263 (749), 126 | 524 (1429), 126 | −389 (−741 to 190), 0.27 |
Primary healthcare contacts (£)
| |||
GP appointments, mean (SD) | 79 (110), 36 | 70 (93), 36 | 8 (−31 to 48), 0.677 |
GP home visit, mean (SD) | 5 (16), 0 | 5 (17), 0 | 0 (−7 to 6), 0.923 |
Parkinson nurse appointments, mean (SD) | 9 (13), 0 | 9 (15), 0 | 0 (−5 to 6), 0.901 |
Community nurse home visit, mean (SD) | 1 (4), 0 | 3 (20), 0 | −3 (−9 to 3), 0.324 |
Total primary healthcare, mean (SD) | 93 (116), 69 | 88 (101), 62 | 5 (−38 to 49), 0.80 |
Social care contacts (£)
| |||
Social/community care assessments, mean (SD) | 70 (217), 0 | 18 (86), 0 | 52 (−15 to 119), 0.126 |
Hours of home care, mean (SD) | 177 (886), 0 | 39 (259), 0 | 138 (−129 to 405), 0.312 |
Hours of day care, mean (SD) | 5 (34), 0 | 0 (0), 0 | 5 (−5 to 15), 0.324 |
Days of residential care, mean (SD) | 0 (0), 0 | 61 (408), 0 | −61 (−173 to 52), 0.290 |
Days of nursing care, mean (SD) | 0 (0), 0 | 42 (279), 0 | −42 (−123 to 40), 0.318 |
Total social care, mean (SD) | 252 (1023), 0 | 159 (753), 0 | 92 (−268 to 453), 0.62 |
HRQoL, QALYs and cost-effectiveness analysis
Intervention (n=48) | Control (n=45) | Effect size (95% CI)*, P-value | |
---|---|---|---|
Baseline | 0.70 (0.22) | 0.65 (0.23) | |
10 weeks | 0.66 (0.29) | 0.66 (0.23) | −0.04 (−0.12 to 0.05), P=0.395 |
20 weeks | 0.74 (0.29) | 0.62 (0.30) | 0.08 (−0.03 to 0.19), P=0.131 |
Intervention Mean (SD) N=48 | Control Mean (SD) N=45 | Mean difference Mean (95% CI), P-value | ICER (£) Cost per QALY | |
---|---|---|---|---|
QALYs
| 0.40 (0.13) | 0.37 (0.12) | 0.03 (−0.02 to 0.08), 0.32 | |
Total healthcare costs (£)
| 1198 (1192) | 1320 (1676) | −128 (−734 to 478). 0.68 | −4,885 |
Total health and social care costs (£)
| 1444 (1953) | 1479 (1982) | −35 (−817 to 746), 0.93 | −1,358 |