Background A great variation in the organisation of day hospitals (DH) exists in Spain. Some DH are set-up for attending only rheumatology patients, while others attend patients from different specialities and undertake different procedures. Depending on the DH organization patients have to attend for a blood simple, infusion and the rheumatologist clinic for every treatment, or they are able to do it all together on the same day. Nurse-led clinics set-up in a DH for follow-up, monitoring disease activity, comorbidities assessment, patient education care coordination and telephone help-line services for rheumatoid arthritis patients (RA) under intravenous (IV) biologic therapies are not widely available.
Objectives To make a cost comparison analysis of three possible strategies of day hospital management of RA patients receiving infliximab IV biologic therapy.
Methods A model of cost comparison economic evaluation based on a previously determined decision tree which represented three different models of day hospital was analised. Direct and indirect cost of each strategy were evaluated. These costs were calculated based on a sample of 145 patients with RA (78% female, mean age 58 years old, RF+ 67%, mean disease duration 11.5 years) who have received infliximab in the Alicante General Hospital-DH between years 2000-2010. The three compared strategies (S) were: S1–DH with patients attending three times for each IV infusion-; S2–DH with patients attending for blood test+IV+rheumatologist on the same day-; S3 –S2+ rheumatology nurse-led clinic on the same day.
Results A lower cost was generated per patient/year comparing S1 and S3. The saving was up to 900€ (Table 1
Conclusions The organization of a DH determines the frequency of patients attending the clinic, and so then, the associated costs. The effect and consequences of incorporating a nurse-led clinic for the care and management of RA patients in DH is difficult to quantify. Nevertheless, based in our model, this incorporation is cost-effective.
Disclosure of Interest None Declared