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

Published online by Cambridge University Press:  09 July 2009

Gary Ginsberg ,
Isaac Marks  and
Helena Waters
Gary Ginsberg
Affiliation:
From the Institute of Psychiatry, London
Isaac Marks*
Affiliation:
From the Institute of Psychiatry, London
Helena Waters
Affiliation:
From the Institute of Psychiatry, London
*
1Address for correspondence: Professor Isaac Marks, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.
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Synopsis

In 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.

Type
Research Article
Information
Psychological Medicine , Volume 14 , Issue 3 , August 1984 , pp. 683 - 690
Copyright
Copyright © Cambridge University Press 1984

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