Cost–benefit analysis of a controlled trial of nurse therapy for neuroses in primary care

Abstract

SynopsisIn a randomized, controlled trial neurotic patients (mainly phobics and obsessive-compulsives) in primary care were assigned to behavioural psychotherapy from a nurse therapist or to routine care from their general practitioner. At the end of one year clinical outcome was significantly better in patients cared for by the nurse therapist. Economic outcome to one year, compared with the year before entering the trial, showed a slight decrease in the use of resources by the nurse therapist group (N = 22), and an increase in resource usage in the GP-treated group (N = 28), mainly due to the letter's increased absence from work and more hospital treatment and drugs. On the reasonable assumptions that nurse therapists treat 46 patients a year and that such patients treated behaviourally maintain their gains for 2 years, the economic benefits to society from nurse therapists treating such patients may outweigh the costs. This excludes any monetary value on the substantial clinical gains such as reduction in fear and anxiety. However, the numbers are small, few economic differences were significant, and many patients either did not complete the trial or waiting-list periods or they failed to return economic data. Conclusions must thus be tempered with caution, even though pre-treatment demographic and clinical data of non-returners were comparable with those of returners, and though the few drop-outs who could be rated at one year had not improved. The findings cannot be extrapolated to other types of clinical problem and treatment.

Economic Evaluation of Mental Health Care Interventions. A Review

“…Of the selected studies, 34 described the losses during follow-up. The highest loss rate was 57% of the suitable patients, in a study by Ginsberg et al 130 …”

“…30 Only a few studies included in our review used blinding. 60,61,97,113,115,[130][131][132][133] This may be because blinding is not always practicable and may require considerable time and effort.…”

“…Especially in mental health care, psychosocial costs such as grief and loss of well-being play a major role. Seven studies 1,68,72,78,118,130,145 mentioned these costs as being relevant and tried to fit them into the analysis.…”

“…One can use records available through health service suppliers. 3,56,57,68,69,76,79,102,108,110,116,121,122,127,130,[144][145][146][147] In addition, caseregisters or other macro-level records (e.g. Medicaid records, California County Public Mental Health Information System) can be employed to glean information from several institutions.…”

Changes in referral rates following community psychiatric nurse attachment to a primary care team

“…Increasingly, CPNs are now being attached to pri mary care teams where they have already shown their value in being more effective than routine treatment from a GP for neurotic patients, this leading to a small but non-significant fall in total resource usage and to patients expressing a preference for treatment in the primary care setting (Marks, 1985;Ginsberg et al, 1984).…”