| Abstract: | ABSTRACT: BACKGROUND: Regular review and support for asthma self-management is promoted in guidelines. A randomised controlled trial suggested that unscheduled health care usage was similar when patients were offered self management support by a lay-trainer or practice nurses. METHODS: Following the RCT, a costing study was undertaken using the trial data to account for the cost of delivery of the service under both strategies and the resulting impact on unscheduled healthcare (measure of effectiveness) in this trial. RESULTS: One year data (n = 418) showed that 29% (61/205) of the nurse group required unscheduled healthcare (177 events) compared with 30.5% (65/213) for lay-trainers (178 events).The training costs for the lay-trainers were greater than nurses ([pound sign]36 versus [pound sign]18 respectively per patient, p<0.001), however, the consultation cost for lay-trainers were lower than nurses ([pound sign]6 per patient versus [pound sign]24, p<0.001). If the cost of unscheduled healthcare are accounted for then the costs of nurses is [pound sign]161, and [pound sign]135 for lay-trainers (mean difference [pound sign]25, [95% CI = -[pound sign]97, [pound sign]149, p = 0.681]). The total costs (delivery and unscheduled healthcare) were [pound sign]202 per patient for nurses versus [pound sign]178 for lay-trainers, (mean difference [pound sign]24, [95%CI = -[pound sign]100, [pound sign]147, p = 0.707]). CONCLUSIONS: There were no significant differences in the cost of training and healthcare delivery between nurse and lay trainers, and no significant difference in the cost of unscheduled health care use. |
