Health care spending in the U.S. is rising rapidly. While currently at $2 trillion per year, this figure is projected to double to $4 trillion by 2020, according to the National Center for Health Statistics. To help stem this rise, there is a growing need to conduct economic evaluations of both new and existing health care practices. Nurses, the largest component of the health care workforce, are well positioned to contribute to decisions on the efficient use of health care resources.
This was the motivation for a recent workshop, co-sponsored by the National Institute of Nursing Research and the NIH Office of Rare Diseases, titled “Integrating Cost-Effectiveness Analysis into Clinical Research.” The workshop brought together over 50 experts in nursing, health care and economics to discuss ways to use cost-effectiveness analysis (CEA) in studies conducted by nurse scientists and other researchers.
NINR deputy director Dr. Mary Kerr noted, “The average American spends $7,100 per year for health care-related costs. NINR supports studies that not only look at how interventions can keep individuals healthy, but also…have a positive impact on resources.”
Presentations during the 2-day event covered a range of topics. As defined by Dr. Patricia Stone of Columbia University School of Nursing, CEA involves a comparative analysis of alternative courses of action in terms of both their costs and consequences. Dr. Kevin Frick, a professor at Johns Hopkins Bloomberg School of Public Health and a member of the NINR Advisory Council, remarked that CEA is only one component of the research needed to inform health policy and will not necessarily result in less health care spending. Dr. Mark Roberts, a professor of medicine at the University of Pittsburgh, noted that a health care therapy must first be proven effective before being evaluated as cost-effective.
An Effective Intervention
As one example of an intervention that is both effective and cost-effective, Dr. Bernadette Melnyk, dean of Arizona State University College of Nursing, presented her research with parents of preterm infants in the NINR-funded study, Creating Opportunities for Parent Empowerment (COPE). According to Melnyk, in 2005 alone, preterm births cost the U.S. at least $26.2 billion, or $51,600 for every infant born preterm.
COPE teaches parents about typical preterm infant characteristics and behaviors, helping them care for and interact with their infants in developmentally appropriate ways. This program contributed to shortening the infants’ hospital stays, resulting in a savings of $5,000 per infant. After publishing these results in the journal Pediatrics, Melnyk’s office received calls about COPE from neonatal units across the country. Melnyk’s vision is to improve the clinical care and the health outcomes for all premature infants and their parents, while lowering the costs of care.
A Global Concern
At the end of the workshop, participants noted that concern about health care costs reaches around the world. They identified the need for interdisciplinary collaboration between clinical researchers and economists, as well as for researchers to better disseminate their results to health care policy makers and the public.
Participants emphasized that cost-effectiveness is not the same as cost-cutting. Rather, they observed that researchers will be asked to verify that health care interventions are both effective and cost-effective. Improving the use of CEA will help inform health care decisions on the allocation of health care resources at the highest level.