Assessing the quality of economic evaluations of clinical nurse specialists and nurse practitioners: A systematic review of cost-effectiveness

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  • Deborah A.Marshall (a); Faith Donald (b); Sarah Lacny (c); Kim Reid (d); Denise Bryant-Lukosius (e); Nancy Carter (f); Renee Charbonneau-Smith (g); Patricia Harbman (h, i); Sharon Kaasalainen (j); Kelley Kilpatrick (k); Ruth Martin-Misener (l); Alba DiCenso (m) - (a) Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Health Research Innovation Centre, Calgary, AB, Canada; (b) Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada; (c) Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Health Research Innovation Centre, Calgary, AB, Canada; (d) KJ Research, Rosemere, QC, Canada; (e) School of Nursing and Department of Oncology, McMaster University, Hamilton, ON, Canada; (f) School of Nursing, McMaster University, Health Sciences Centre, Hamilton, ON, Canada; (g) School of Nursing, McMaster University, Health Sciences Centre, Hamilton, ON, Canada; (h) Health Interventions Research Centre, Ryerson University, Toronto, ON, Canada; (i) School of Nursing, McMaster University, Health Sciences Centre, Hamilton, ON, Canada; (j) School of Nursing, McMaster University, Health Sciences Centre, Hamilton, ON, Canada; (k) Faculty of Nursing, Université de Montreal, Marguerite d׳Youville Pavilion, Montréal, QC, Canada; (l) School of Nursing, Dalhousie University, Halifax, NS, Canada; (m) School of Nursing and Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada

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http://hdl.handle.net/10755/19967
Abstract
A limited number of randomized controlled trials (RCTs) including economic analysis have supported the cost-effectiveness of nurse practitioners and clinical nurse specialists delivering care in a variety of settings. Our objective was to examine the quality of economic evaluations in this body of literature using the Quality of Health Economic Studies (QHES) tool, and highlight which questions of the quality assessment tool are being addressed adequately or require further attention within this body of literature. Of 43 RCTs included in our systematic review, the majority (77%) fell in the poor study quality quartile with an average total QHES score of 39 (out of 100). Only three studies (7%) were evaluated as high quality. Inter-rater agreement (prior to consensus process) was high (83% agreement). Four criteria for the quality of economic evaluations were consistently addressed: specification of clear, measurable objectives; pre-specification of subgroups for subgroup analyses; justified conclusions based on study results; and disclosure of study funding source. A clear statement of the primary outcome measures, incremental analysis, and assessment of uncertainty were often unclear or missing. Due to poor methodological quality, we currently lack a solid evidence base to draw clear conclusions about the cost-effectiveness of nurse practitioners and clinical nurse specialists. Higher quality economic evaluations are required to inform these questions.
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2020-02-05T20:03:19Z
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Type Information
TypeArticle
AcquisitionIndexed from External Source (Per Rights Granted in Creative Commons License)
Review TypeExternal Review: Previously Published Material
FormatText-based Document
Category Information
Evidence LevelSystematic Review
Research ApproachN/A
KeywordsClinical Nurse Specialists;
Cost-effectiveness;
Economic Evaluation;
Nurse Practitioners;
Quality Assessement
Original Publication Info
PublisherElsevier
Date2015-07-15
VersionPublisher’s Version
DOIhttps://doi.org/10.1016/j.npls.2015.07.001
CitationMarshall, D. A., Donald, F., Lacny, S., Reid, K., Bryant-Lukosius, D., Carter, N., … Dicenso, A. (2015). Assessing the quality of economic evaluations of clinical nurse specialists and nurse practitioners: A systematic review of cost-effectiveness. NursingPlus Open, 1, 11–17. doi.10.1016/j.npls.2015.07.001
ISSN2352-9008
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