Seminars in arthritis and rheumatism · 2025
Cost-effectiveness of nurse-led home monitoring of serum urate for gout patients starting with urate-lowering therapy in secondary care: a modeling study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
van der Ven Jeffrey, Flendrie Marcel, van Dijck Fenne, Wientjes Maike H M, van Herwaarden Noortje, Riches Philip L, van den Bemt Bart J F, Verhoef Lise M
Аннотация
OBJECTIVES: To assess the cost-effectiveness of nurse-led home monitoring of serum urate (SU) versus usual care for gout patients starting urate-lowering therapy (ULT) in a secondary care setting. Additionally, the intervention's impact on nurse and rheumatologist time investment was evaluated.
METHODS: A cost-effectiveness modeling study was conducted from a societal perspective. Home monitoring involved rheumatology nurses remotely supporting patients with ULT dose adjustments according to treat-to-target (T2T), while patients conducted SU testing at home. Usual care entailed hospital-based SU monitoring with rheumatologist visits also following the T2T approach. A decision tree (6-month period) and a Markov model (18 months) were employed to simulate a two-year timeframe. Costs included medications, provider time, laboratory/home testing expenses, travel, productivity losses, and gout flare-related care. Health outcomes were measured in Quality-Adjusted Life Years (QALYs). Cost-effectiveness was determined via probabilistic sensitivity analyses using a €20,000 per QALY willingness-to-pay threshold.
RESULTS: Home monitoring proved cost-effective, yielding a mean incremental net monetary benefit (iNMB) of €91.43 (credible interval (CI): -56.49 to 274.09). QALYs changed marginally from 1.455 (CI: 1.389 to 1.517) under usual care to 1.459 (CI: 1.391 to 1.523) with home monitoring over two years. Rheumatologist time was reduced by 41 min (CI: -116 to 11), though nurses spent an additional 52 min (CI: 4 to 143).
CONCLUSION: This modeling study demonstrates that nurse-led home monitoring of serum urate levels in gout patients starting ULT is likely to be cost-effective compared to usual secondary gout care.
METHODS: A cost-effectiveness modeling study was conducted from a societal perspective. Home monitoring involved rheumatology nurses remotely supporting patients with ULT dose adjustments according to treat-to-target (T2T), while patients conducted SU testing at home. Usual care entailed hospital-based SU monitoring with rheumatologist visits also following the T2T approach. A decision tree (6-month period) and a Markov model (18 months) were employed to simulate a two-year timeframe. Costs included medications, provider time, laboratory/home testing expenses, travel, productivity losses, and gout flare-related care. Health outcomes were measured in Quality-Adjusted Life Years (QALYs). Cost-effectiveness was determined via probabilistic sensitivity analyses using a €20,000 per QALY willingness-to-pay threshold.
RESULTS: Home monitoring proved cost-effective, yielding a mean incremental net monetary benefit (iNMB) of €91.43 (credible interval (CI): -56.49 to 274.09). QALYs changed marginally from 1.455 (CI: 1.389 to 1.517) under usual care to 1.459 (CI: 1.391 to 1.523) with home monitoring over two years. Rheumatologist time was reduced by 41 min (CI: -116 to 11), though nurses spent an additional 52 min (CI: 4 to 143).
CONCLUSION: This modeling study demonstrates that nurse-led home monitoring of serum urate levels in gout patients starting ULT is likely to be cost-effective compared to usual secondary gout care.