Economic evaluation of nurse-led intensive care follow-up programmes compared with standard care: the PRaCTICaL trial
Abstract
Objective Following intensive care discharge, many patients suffer severe physical and psychological morbidity and a continuing high use of health services. Follow-up programmes have been proposed to improve the outcomes for these patients. We tested the hypothesis that nurse-led intensive care follow-up programmes are cost-effective.Methods A pragmatic, multicentre, randomised controlled trial of nurse-led intensive care unit follow-up programmes versus standard care. A cost-utility analysis was conducted after 12 months' follow-up to compare the two interventions. Costs were assessed from the perspective of the UK NHS and outcomes were measured in quality-adjusted life years (QALYs) based upon responses to the EQ-5D administered at baseline, 6 and 12 months.Results A total of 286 patients were recruited to the trial. Total mean cost was £ 5,789 for standard care and £ 7,577 for the discharge clinic. The adjusted difference in means was £ 2,435 [95 % confidence interval (CI) -297 to 5,566]. Mean QALYs were 0.58 for standard care and 0.60 for the discharge clinic. The adjusted mean difference was -0.003 (95 % CI -0.066 to 0.060). If society were willing to pay £ 20,000 per QALY then there would be a 93 % chance that standard care would be considered most efficient.Conclusions A nurse-led intensive care unit (ICU) follow-up programme showed no evidence of being cost-effective at 12 months. Further work should focus on evidence-based development of discharge clinic services and current ICU follow-up programmes should review their practice in light of these results.
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There were four further cost-utility analyses that used economic modelling rather than empirical methods, and two cost-consequence analyses.
“There were also four further CUAs that used economic modelling rather than empirical methods [8–10, 34], and two cost-consequence analyses [16, 35].”
From Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review (2019) · cites this paper as [34]
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Depression and quality of life in older persons: A review
Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A.-S. (2015) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000437299 · Cited by 14,152 · see citing works
Methods for the Economic Evaluation of Health Care Programmes
Drummond, M. E., Sculpher, M. J., Torrance, G. W., O’Brien, B. J., & Stoddart, G. L. (2005) · doi:10.1093/oso/9780198529446.001.0001 · Cited by 13,648 · see citing works
(1958) · Journal of the American Pharmaceutical Association (Scientific ed ) · doi:10.1002/jps.3030470133 · Cited by 2,491 · see citing works
Assessment of a new self-rating scale for post-traumatic stress disorder
Davidson, J., Book, S., Colket, J., Tupler, L., Roth, S., David, D., Hertzberg, M. A., Mellman, T., Beckham, J., Smith, R. D., et al. (1997) · Psychological Medicine · doi:10.1017/s0033291796004229 · Cited by 954 · see citing works
A social tariff for EuroQol: results from a UK general population surveyPreprint
Dolan, P., Gudex, C. M., Kind, P., & Williams, A. (1995) · RePEc: Research Papers in Economics · Cited by 611 · see citing works
Schelling, G., Stoll, C., Haller, M., Briegel, J., Manert, W., Hummel, T., Lenhart, A., Heyduck, M., Polasek, J., Meier, M., et al. (1998) · Critical Care Medicine · doi:10.1097/00003246-199804000-00011 · Cited by 601 · see citing works
Survival, morbidity, and quality of life after discharge from intensive care
EDDLESTON, J. M., White, P., & Guthrie, E. (2000) · Critical Care Medicine · doi:10.1097/00003246-200007000-00018 · Cited by 579 · see citing works
Cuthbertson, B. H., Rattray, J., Campbell, M. K., Gager, M., Roughton, S., Smith, A., Hull, A., Breeman, S., Norrie, J., Jenkinson, D., et al. (2009) · BMJ · doi:10.1136/bmj.b3723 · Cited by 488 · see citing works
Self-citationQuality of life in the five years after intensive care: a cohort study
Cuthbertson, B. H., Roughton, S., Jenkinson, D., MacLennan, G., & Vale, L. D. (2010) · Critical Care · doi:10.1186/cc8848 · Cited by 476 · see citing works
Self-citationThe Personal Social Services Research Unit
Hallam, A., Darton, R. A., McIntosh, E., & Netten, A. (1994) · Kent Academic Repository (University of Kent) · Cited by 342 · see citing works
Kapfhammer, H. P., Rothenhäusler, H. B., Krauseneck, T., Stoll, C., & Schelling, G. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.1.45 · Cited by 335 · see citing works
Psychological problems following ICU treatment*
Scragg, P., Jones, A., & Fauvel, N. (2001) · Anaesthesia · doi:10.1046/j.1365-2044.2001.01714.x · Cited by 316 · see citing works
Post-traumatic stress disorder after critical illness requiring general intensive care
Cuthbertson, B. H., Hull, A. M., Strachan, M., & Scott, J. (2004) · Intensive Care Medicine · doi:10.1007/s00134-003-2004-8 · Cited by 284 · see citing works
Self-citationQuality of life before and after intensive care
Cuthbertson, B. H., Scott, J., Strachan, M., Kilonzo, M. M., & Vale, L. D. (2005) · Anaesthesia · doi:10.1111/j.1365-2044.2004.04109.x · Cited by 207 · see citing works
Self-citationA national survey of intensive care follow‐up clinics
Griffiths, J., Barber, V. S., Cuthbertson, B. H., & Young, D. (2006) · Anaesthesia · doi:10.1111/j.1365-2044.2006.04792.x · Cited by 201 · see citing works
Self-citationDeterminants of long-term survival after intensive care*
Williams, T. A., DOBB, G. J., Finn, J., Knuiman, M. W., Geelhoed, E. A., Lee, K., & Webb, S. A. R. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e318170a405 · Cited by 200 · see citing works
The intensive care experience: development of the ICE questionnaire
Rattray, J. E., Johnston, M., & Wildsmith, J. A. W. (2004) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2004.03066.x · Cited by 146 · see citing works
Wright, J., Plenderleith, L., & Ridley, S. (2003) · Anaesthesia · doi:10.1046/j.1365-2044.2003.03205.x · Cited by 141 · see citing works
Quality of life after prolonged intensive care
Niskanen, M. M., Ruokonen, E., Takala, J. A., Rissanen, P., & Kari, A. (1999) · Critical Care Medicine · doi:10.1097/00003246-199906000-00035 · Cited by 136 · see citing works
Changes in quality of life after intensive care: comparison with normal data
Ridley, S., Chrispin, P., Scotton, H., Rogers, J., & Lloyd, D. (1997) · Anaesthesia · doi:10.1111/j.1365-2044.1997.073-az0068.x · Cited by 129 · see citing works
Clinical review: Intensive care follow-up--what has it told us?
Broomhead, L. R., & Brett, S. J. (2002) · Critical Care · doi:10.1186/cc1532 · Cited by 82 · see citing works
Cuthbertson, B. H., Rattray, J. E., Johnston, M., Wildsmith, J. A. W., Wilson, E., Hernendez, R., Ramsay, C. R., Hull, A. M., Norrie, J. D., & Campbell, M. (2007) · BMC Health Services Research · doi:10.1186/1472-6963-7-116 · Cited by 51 · see citing works
Self-citationA multidisciplinary follow-up clinic after patients' discharge from ITU
Crocker, C. (2003) · British Journal of Nursing · doi:10.12968/bjon.2003.12.15.11420 · Cited by 50 · see citing works
Lipsett, P. A., Swoboda, S. M., Campbell, K. A., Cornwell, E., Dorman, T., & Pronovost, A. P. J. (2000) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/00005373-200010000-00024 · Cited by 32 · see citing works
Quality of Life after Intensive Care
Kerridge, R. K., Brooks, R., & Hillman, K. (1994) · Springer eBooks · doi:10.1007/978-3-642-85068-4_78 · Cited by 16 · see citing works
Flagged first, then by citations
2 of the 28 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors
Schofield-Robinson, O. J., Lewis, S. R., Smith, A. F., McPeake, J., & Alderson, P. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012701.pub2 · Cited by 246 · see citing works
Jensen, J. F., Thomsen, T., Overgaard, D., Bestle, M. H., Christensen, D., & Egerod, I. (2015) · Intensive Care Medicine · doi:10.1007/s00134-015-3689-1 · Cited by 185 · see citing works
Roberts, S. L. E., Healey, A., & Sevdalis, N. (2019) · Implementation Science · doi:10.1186/s13012-019-0901-7 · Cited by 161 · see citing works
Chan, R. J., Marx, W., Bradford, N., Gordon, L. G., Bonner, A., Douglas, C., Schmalkuche, D., & Yates, P. M. (2018) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2018.02.002 · Cited by 80 · see citing works
Hall, P. S., Mitchell, E., Smith, A. F., Cairns, D. A., Messenger, M. P., Hutchinson, M., Wright, J. M., Vinall‐Collier, K. A., Corps, C., Hamilton, P., et al. (2018) · Health Technology Assessment · doi:10.3310/hta22320 · Cited by 40 · see citing works
A national survey of intensive care follow-up clinics in Australia
Cook, K., Bartholdy, R., Raven, M., Dohren, G. V., Rai, S., Haines, K. J., & Ramanan, M. (2020) · Australian Critical Care · doi:10.1016/j.aucc.2020.03.005 · Cited by 39 · see citing works
Brazzelli, M., Aucott, L., Aceves‐Martins, M., Robertson, C., Jacobsen, E., Imamura, M., Poobalan, A., Manson, P. D., Scotland, G., Kaye, C. T., et al. (2022) · Health Technology Assessment · doi:10.3310/ugez4120 · Cited by 27 · see citing works
Walsh, T. S., Stanworth, S. J., Boyd, J. A., Hope, D., Hemmatapour, S., Burrows, H., Campbell, H., Pizzo, E., Swart, N., & Stephen Morris, A. (2017) · Health Technology Assessment · doi:10.3310/hta21620 · Cited by 24 · see citing works
A Novel Approach to ICU Survivor Care: A Population Health Quality Improvement Project
Snell, K., Beiter, C. L., Hall, E., Junod, A. S., Wilson, B. J., Lepone, D. K., McIntyre, J., Swartz, D. P., Berger, A. L., Kirchner, H. L., et al. (2020) · Critical Care Medicine · doi:10.1097/ccm.0000000000004579 · Cited by 21 · see citing works
Yoshihiro, S., Taito, S., Yamauchi, K., Kina, S., Terayama, T., Tsutsumi, Y., Kataoka, Y., & Unoki, T. (2023) · PeerJ · doi:10.7717/peerj.15260 · Cited by 15 · see citing works
Sloan, E., Parry, S. M., da Silva, A. A., Granger, C. L., Fehlberg, Z., Gustafson, O. D., Voutier, C. R., Short, C. E., & Klaic, M. (2025) · CHEST Critical Care · doi:10.1016/j.chstcc.2025.100142 · Cited by 8 · see citing works
Coors, M., Schüttig, W., Reber, K. C., Darius, H., Holzgreve, A., Karmann, S., Stürtz, A., Zöller, R., Kropp, S., Riesner, P., et al. (2024) · The European Journal of Health Economics · doi:10.1007/s10198-024-01734-7 · Cited by 7 · see citing works
Ulrich, L., Petersen, J. J., Mergenthal, K., Berghold, A., Pregartner, G., Holle, R., & Siebenhofer, A. (2019) · Health Economics Review · doi:10.1186/s13561-019-0221-2 · Cited by 5 · see citing works
Feasibility of Follow-Up Consultations
Prevedello, D., & Preiser, J. (2019) · Lessons from the ICU · doi:10.1007/978-3-030-24250-3_23 · Cited by 3 · see citing works
The Cost-Effectiveness of Nursing Interventions in Cancer Care: Systematic Review
Yazıcıoğlu, İ., Bağçıvan, G., & Kolić, A. (2025) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2025.151907 · Cited by 2 · see citing works
Interventions for adult survivors discharged from the intensive care unit: a scoping review
Wu, T., Yan, F., Zhang, G., Zhao, R., Peng, G., Sun, R., Ma, Y., Han, L., & Liu, J. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-096634 · Cited by 2 · see citing works
Martins, R., Koyner, J., Wald, R., Harenski, K., & Echeverri, J. (2025) · ClinicoEconomics and Outcomes Research · doi:10.2147/ceor.s546850 · Cited by 2 · see citing works
Cost-effectiveness of coronary clinical intervention: a retrospective analysis
Rajasekharan Pillai, K., & Fernandes, S. G. (2019) · Journal of Public Health · doi:10.1007/s10389-019-01029-9 · Cited by 1 · see citing works
Intensive care units follow-up: a scoping review protocol
Prevedello, D., Fiore, M., Créteur, J., & Preiser, J. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-037725 · Cited by 1 · see citing works
Financial Considerations for ICU Follow-Up Clinics
Korzick, K., Perfetti, A. R., & Tomcavage, J. F. (2026) · Cambridge University Press eBooks · doi:10.1017/9781009501477.031
Park, Y., Yun, J.-S., Kim, S., & Park, J.-H. (2026) · Australian Critical Care · doi:10.1016/j.aucc.2025.101529
Utomo, B., Malik, G., & Duncan, R. (2026) · Australian Critical Care · doi:10.1016/j.aucc.2026.101659
- Authors
- Hernández, R. A., Jenkinson, D., Vale, L., & Cuthbertson, B. H.
- Affiliations
- University of Aberdeen (GB)
- Newcastle University (GB)
- Sunnybrook Health Science Centre (CA)
- Corresponding author
- Vale, L.
- Venue
- The European Journal of Health Economics
- Published
- 2013-03-28
- Volume
- 15
- Issue
- 3
- Pages
- 243-252
- ISSN
- 1439-3972 (ISSN-L)
- 1618-7598
- 1618-7601
- OpenAlex
- W1997592243
- Cited by
- 28
- References
- 28
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 1 · 2023: 7 · 2022: 1 · 2020: 3 · 2019: 4 · 2018: 3 · 2017: 1 · 2015: 1
- FWCI
- 0.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- The European Journal of Health Economics (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Medical Research Council (MR/K02325X/1)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Keywords
- intensive care unit discharge, cost-effectiveness, quality-adjusted life years, critical illness survivors, EQ-5D, NHS costs
- MeSH terms
- Continuity of Patient Care, Cost-Benefit Analysis, Critical Care, United Kingdom, Health Services, Humans, Nurses, Patient Care Management, Quality of Life, State Medicine, Quality-Adjusted Life Years
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