Cost analysis of nurse telephone consultation in out of hours primary care: evidence from a randomised controlled trial

Abstract

Objective To undertake an economic evaluation of nurse telephone consultation using decision support software in comparison with usual general practice care provided by a general practice cooperative. Design Cost analysis from an NHS perspective using stochastic data from a randomised controlled trial. Setting General practice cooperative with 55 general practitioners serving 97 000 registered patients in Wiltshire, England. Subjects All patients contacting the service, or about whom the service was contacted during the trial year (January 1997 to January 1998). Main outcome measuresCosts and savings to the NHS during the trial year. Results The cost of providing nurse telephone consultation was £81 237 per annum. This, however, determined a £94 422 reduction of other costs for the NHS arising from reduced emergency admissions to hospital. Using point estimates for savings, the cost analysis, combined with the analysis of outcomes, showed a dominance situation for the intervention over general practice cooperative care alone. If a larger improvement in outcomes is assumed (upper 95% confidence limit) NHS savings increase to £123 824 per annum. Savings of only £3728 would, however, arise in a scenario where lower 95% confidence limits for outcome differences were observed. To break even, the intervention would have needed to save 138 emergency hospital admissions per year, around 90% of the effect achieved in the trial. Additional savings of £16 928 for general practice arose from reduced travel to visit patients at home and fewer surgery appointments within three days of a call.Conclusions Nurse telephone consultation in out of hours primary care may reduce NHS costs in the long term by reducing demand for emergency admission to hospital. General practitioners currently bear most of the cost of nurse telephone consultation and benefit least from the savings associated with it. This indicates that the service produces benefits in terms of service quality, which are beyond the reach of this cost analysis.

Design and Analysis of Diagnostic Service Centers

“…While some empirical studies in the clinical literature have shown that nurse lines may generate savings (Lattimer et al 2000), there…”

The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial)

“…34 Odyssey PatientAssess has been evaluated in a number of other RCTs, and its clinical effectiveness and cost-effectiveness in settings other than in-hours general practice is already established. For instance, it has been demonstrated to be safe and cost saving in the long term in one study 5,16 involving a co-investigator compared with GP telephone triage in a trial of out-of-hours primary care consultations. That study remains the largest trial of nurse telephone triage to date.…”

“…That study remains the largest trial of nurse telephone triage to date. 5,16 Furthermore, in excess of 60% of PCTs currently commission out-of-hours primary care services that use nurses to triage patients by telephone, supported by Odyssey PatientAssess (Chris Coyne, Plain Healthcare, 2008, personal communication). However, the findings and experience of out-of-hours primary care (providing care for around 10.8 million contacts per year in UK) cannot necessarily be generalised to the very different system providing in-hours primary care and experiencing around 1 million contacts per working day.…”

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“…These applications also substantially decreased emergency department visits and hospitalizations, prolonged survival, and led to impressive cost savings [23,24].…”