A cost-effectiveness analysis : shared-care compared with nurse-practitioner and specialist clinics.

Information technology has made possible new forms of care such as shared-care which is a method of co-ordinating the care of individuals who have a condition requiring long-term follow-up. It is, however, essential to evaluate new systems and to compare their effectiveness, acceptability and cost with the methods which they replace. The West of Scotland Shared-Care Scheme for Hypertension was set up in 1986 to provide shared-care for well-controlled hypertensive patients attending an outpatient specialist clinic. The Scheme was examined for feasibility, for acceptability to patients and doctors and for cost-effectiveness compared with two alternatives namely, a specialist outpatient clinic and a nurse-practitioner clinic. This paper describes the methods used to carry out the cost-effectiveness analysis and the principal results. The measure of effectiveness used was the number of patients who had a complete review carried out in one year of the study period. The costs measured were all variable costs to the patient and to the health service, that is, the costs which increase as the number of patients increase. Briefly, the results showed that the Shared-Care Scheme is more cost-effective than the specialist outpatient clinic in ensuring patient review. The cost-effectiveness of the Shared-Care Scheme and the nurse-practitioner clinic is approximately the same; however, the nurse-practitioner clinic costs the health service less while the Shared-Care Scheme is less costly to the patients