Cost effectiveness analysis for nursing research

Abstract

Background: With ever-increasing pressure to reduce costs and increase quality, nurses are faced with the challenge of producing evidence that their interventions and care provide value. Cost effectiveness analysis (CEA) is a tool that can be used to provide this evidence by comparative evaluation of the costs and consequences of two or more alternatives.

Objectives: The aim of this article is to introduce the essential components of CEA to nurses and nurse researchers with the protocol of a recently funded cluster randomized controlled trial as an example.

Methods: This article provides (a) a description of the main concepts and key steps in CEA and (b) a summary of the background and objectives of a CEA designed to evaluate a nursing-led pain and symptom management intervention in rural communities compared with the current usual care.

Discussion: As the example highlights, incorporating CEA into nursing research studies is feasible. The burden of the additional data collection required is offset by quantitative evidence of the given intervention's cost and impact using humanistic and economic outcomes. At a time when U.S. healthcare is moving toward accountable care, the information provided by CEA will be an important additional component of the evidence produced by nursing research.

Figure 1

The four quadrants of the cost effectiveness plane. The four quadrants of the cost effectiveness plane provide information on the joint distribution of costs and effects. Quadrant III results show a new option that should be adopted as it is less costly and more effective than usual care. Quadrant II results below the cost effectiveness threshold should be adopted; those above should not as they exceed the predefined threshold (e.g., $50,000 or $100,000 per QALY). Results in quadrant IV could theoretically have a similar threshold if there is a willingness to accept decreased effectiveness to reduce cost, but in practice, a less effective option is not adopted. Adapted from “The CE Plane: A graphic Representation of Cost-Effectiveness” by W.C. Black, 1990, Medical Decision Making, 10, 212–214. Copyright 1990, Sage Publications. Used with permission.

Figure 2

Cost effectiveness acceptability curve. This simulated cost effectiveness acceptability curve shows that the probability that the new option is cost-effective, compared to the comparator, is .819 at a willingness-to-pay threshold of $50,000/QALY. The probability at $100,000/QALY is slightly higher, at .832.