Early neurologically focused follow-up after cardiac arrest is cost-effective: A trial-based economic evaluation
Research output: Contribution to journal › Article › Academic › peer-review
OBJECTIVE: To evaluate the cost-effectiveness of an early intervention service for cardiac arrest survivors called 'Stand still…., and move on' from a societal perspective.
INTERVENTION: This concise nursing intervention consists of screening for cognitive and emotional problems, information provision and support, self-management promotion, and further referral if necessary. Earlier research confirmed the feasibility of the intervention and its effectiveness in improving emotional functioning and quality of life.
METHODS: In this multicentre randomized controlled trial with one year follow-up 185 patients were included between April 2007 and December 2010. The experimental group received the intervention, the control group received care-as-usual. Intervention costs, other direct healthcare costs (e.g. hospital care, rehabilitation, medication, home care) and indirect costs (productivity loss) were measured during ten months using monthly cost-diaries. The economic evaluation comprised a cost-utility analysis (SF-36) and a cost-effectiveness analysis (QOLIBRI) using bootstrapping (5000 replications) to quantify uncertainty concerning the Incremental Cost Effectiveness Ratio (ICER), and the probability of the intervention being cost-effective was estimated. To check the robustness of the findings, two sensitivity analyses were performed using the EQ-5D and the complete cases respectively.
RESULTS: Of 136 (74%) participants sufficient data concerning costs were collected to be included in this economic evaluation. Intervention costs were on average €127 (SD 85). No significant differences between groups were found with regard to overall costs. The ICERs of the cost-utility and the cost-effectiveness analyses supported the cost-effectiveness of the intervention. The probability of the intervention being cost-effective was 54% - 76% for the SF-36 and 94% for the QOLIBRI. Findings were robust.
CONCLUSION: The intervention 'Stand still…, and move on' has positive societal economic effects and has a high probability to be cost-effective. Implementation in regular healthcare is recommended.
TRIAL REGISTRATION: ISRCTN74835019.
- Cardiac arrest, Follow-up, Intervention, Economic evaluation, Cost-effectiveness, QUALITY-OF-LIFE, TELEPHONE INTERVENTION, STAND STILL, HEAD-INJURY, SURVIVORS, HEALTH, CAREGIVERS, THERAPY, IMPACT, EQ-5D