Cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial
Objective: To evaluate the cost-effectiveness of an educational outreach intervention to improve primary respiratory care by South African nurses. Methods: Cost-effectiveness analysis alongside a pragmatic cluster randomised controlled trial, with individual patient data. The intervention, the Pract...
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ftuniveastangl:oai:ueaeprints.uea.ac.uk:32097 2023-06-11T04:15:49+02:00 Cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial Fairall, Lara Bachmann, Max Zwarenstein, Merrick Bateman, Eric D. Niessen, Louis Lombard, Carl Majara, Bosielo English, René Bheekie, Angeni van Rensburg, Dingie Mayers, Pat Peters, Annatjie Chapman, Ronald 2010 https://ueaeprints.uea.ac.uk/id/eprint/32097/ https://doi.org/10.1111/j.1365-3156.2009.02455.x unknown Fairall, Lara, Bachmann, Max, Zwarenstein, Merrick, Bateman, Eric D., Niessen, Louis, Lombard, Carl, Majara, Bosielo, English, René, Bheekie, Angeni, van Rensburg, Dingie, Mayers, Pat, Peters, Annatjie and Chapman, Ronald (2010) Cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial. Tropical Medicine & International Health, 15 (3). pp. 277-286. ISSN 1365-3156 doi:10.1111/j.1365-3156.2009.02455.x Article NonPeerReviewed 2010 ftuniveastangl https://doi.org/10.1111/j.1365-3156.2009.02455.x 2023-04-27T22:32:17Z Objective: To evaluate the cost-effectiveness of an educational outreach intervention to improve primary respiratory care by South African nurses. Methods: Cost-effectiveness analysis alongside a pragmatic cluster randomised controlled trial, with individual patient data. The intervention, the Practical Approach to Lung Health in South Africa (PALSA), comprised educational outreach based on syndromic clinical practice guidelines for tuberculosis, asthma, chronic obstructive pulmonary disease, pneumonia and other respiratory diseases. The study included 1999 patients aged 15 or over with cough or difficult breathing, attending 40 primary care clinics staffed by nurses in the Free State province. They were interviewed at first presentation, and 1856 (93%) were interviewed 3 months later. Results: The intervention increased the tuberculosis case detection rate by 2.2% and increased the proportion of patients appropriately managed (that is, diagnosed with tuberculosis or prescribed an inhaled corticosteroid for asthma or referred with indicators of severe disease) by 10%. It costs the health service $68 more for each extra patient diagnosed with tuberculosis and $15 more for every extra patient appropriately managed. Analyses were most sensitive to assumptions about how long training was effective for and to inclusion of household and tuberculosis treatment costs. Conclusion: This educational outreach method was more effective and more costly than usual training in improving tuberculosis, asthma and urgent respiratory care. The extra cost of increasing tuberculosis case detection was comparable to current costs of passive case detection. The syndromic approach increased cost-effectiveness by also improving care of other conditions. This educational intervention was sustainable, reaching thousands of health workers and hundreds of clinics since the trial. Article in Journal/Newspaper palsa University of East Anglia: UEA Digital Repository Tropical Medicine & International Health 15 3 277 286 |
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University of East Anglia: UEA Digital Repository |
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ftuniveastangl |
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description |
Objective: To evaluate the cost-effectiveness of an educational outreach intervention to improve primary respiratory care by South African nurses. Methods: Cost-effectiveness analysis alongside a pragmatic cluster randomised controlled trial, with individual patient data. The intervention, the Practical Approach to Lung Health in South Africa (PALSA), comprised educational outreach based on syndromic clinical practice guidelines for tuberculosis, asthma, chronic obstructive pulmonary disease, pneumonia and other respiratory diseases. The study included 1999 patients aged 15 or over with cough or difficult breathing, attending 40 primary care clinics staffed by nurses in the Free State province. They were interviewed at first presentation, and 1856 (93%) were interviewed 3 months later. Results: The intervention increased the tuberculosis case detection rate by 2.2% and increased the proportion of patients appropriately managed (that is, diagnosed with tuberculosis or prescribed an inhaled corticosteroid for asthma or referred with indicators of severe disease) by 10%. It costs the health service $68 more for each extra patient diagnosed with tuberculosis and $15 more for every extra patient appropriately managed. Analyses were most sensitive to assumptions about how long training was effective for and to inclusion of household and tuberculosis treatment costs. Conclusion: This educational outreach method was more effective and more costly than usual training in improving tuberculosis, asthma and urgent respiratory care. The extra cost of increasing tuberculosis case detection was comparable to current costs of passive case detection. The syndromic approach increased cost-effectiveness by also improving care of other conditions. This educational intervention was sustainable, reaching thousands of health workers and hundreds of clinics since the trial. |
format |
Article in Journal/Newspaper |
author |
Fairall, Lara Bachmann, Max Zwarenstein, Merrick Bateman, Eric D. Niessen, Louis Lombard, Carl Majara, Bosielo English, René Bheekie, Angeni van Rensburg, Dingie Mayers, Pat Peters, Annatjie Chapman, Ronald |
spellingShingle |
Fairall, Lara Bachmann, Max Zwarenstein, Merrick Bateman, Eric D. Niessen, Louis Lombard, Carl Majara, Bosielo English, René Bheekie, Angeni van Rensburg, Dingie Mayers, Pat Peters, Annatjie Chapman, Ronald Cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial |
author_facet |
Fairall, Lara Bachmann, Max Zwarenstein, Merrick Bateman, Eric D. Niessen, Louis Lombard, Carl Majara, Bosielo English, René Bheekie, Angeni van Rensburg, Dingie Mayers, Pat Peters, Annatjie Chapman, Ronald |
author_sort |
Fairall, Lara |
title |
Cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial |
title_short |
Cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial |
title_full |
Cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial |
title_fullStr |
Cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial |
title_full_unstemmed |
Cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial |
title_sort |
cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial |
publishDate |
2010 |
url |
https://ueaeprints.uea.ac.uk/id/eprint/32097/ https://doi.org/10.1111/j.1365-3156.2009.02455.x |
genre |
palsa |
genre_facet |
palsa |
op_relation |
Fairall, Lara, Bachmann, Max, Zwarenstein, Merrick, Bateman, Eric D., Niessen, Louis, Lombard, Carl, Majara, Bosielo, English, René, Bheekie, Angeni, van Rensburg, Dingie, Mayers, Pat, Peters, Annatjie and Chapman, Ronald (2010) Cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial. Tropical Medicine & International Health, 15 (3). pp. 277-286. ISSN 1365-3156 doi:10.1111/j.1365-3156.2009.02455.x |
op_doi |
https://doi.org/10.1111/j.1365-3156.2009.02455.x |
container_title |
Tropical Medicine & International Health |
container_volume |
15 |
container_issue |
3 |
container_start_page |
277 |
op_container_end_page |
286 |
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1768372954970718208 |