Cost-Effectiveness of an Evidence-Based Standardized Nursing Intervention Model for Immobile Stroke Patients in China

Background: While an evidence-based standardized nursing intervention model (SNIM) for immobile patients can improve clinic outcomes, less is known about the cost-effectiveness of the SNIM. We evaluate the cost-effectiveness of the SNIM for immobile stroke patients in China. Methods: This is a pre-test/post-test study, using propensity score (PS) matching on 5932 patients divided into two groups based on a routine and SNIM nursing care cohort. Total healthcare costs were extracted from the hospital information system, with the health outcome effectiveness of the SNIM measured using the EQ-5D instrument and the cost-effectiveness of the SNIM measured by the incremental cost-effectiveness ratio (ICER) with a time horizon of 3 months. Findings: Compared to routine care, SNIM decreased the total costs of stroke patients CN¥4,600 (95%CI: [-7050, -2151]), while increasing QALY 0.009 (95%CI: [0.005, 0.013]). The ICERs over 3 months was CN¥-- 517,011/QALY (95%CI: [-1111442, -203912]). Subgroup analysis reveals that both the quality of life and cost effectiveness improved significantly for ischemic patients and in tertiary hospitals while for hemorrhagic patients and in non-tertiary hospitals only the quality of life improved significantly. Interpretation: Findings from this first cost-effectiveness analysis in immobile stroke patients provide evidence that an evidence-based SNIM provides significant cost saving, but mainly in ischemic patients and tertiary hospitals. Wider adoption of such SNIM programs may be a sensible approach to reducing the burden of stroke and for immobile patients more generally. Funding Statement: The National Health and Family Planning Commission (Beijing, China) [grant numbers 201502017]. Declaration of Interests: The authors declare no competing interests relevant to this manuscript. Ethics Approval Statement: The study was ethically approved by the authorities of the 25 cooperating hospitals and participants signed a written informed consent before enrollment. For patients with aphasia to consent, consent was signed by a family member.