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Table 5 Details of included studies (n = 15)

From: Are multidisciplinary teams in secondary care cost-effective? A systematic review of the literature

Authors, date, and country

MDT team composition

Patient group or disease; sample size

Study design; type of economic evaluation

Comparison group

Outcome measures

Costs included

Findings

RCTs assessing cost-effectiveness of MDTs in non-cancer care

Geriatric care

Collard et al., 1985, [34] USA

Primary nurse, social worker, physician, physical therapist, occupational therapist, medical director

Geriatric patients; treatment = 218, control = 477

RCT; cost-consequences analysis

Usual care i.e. no MDT

Health status, complications during hospitalisation, use of physical/chemical restraints at 5 months

Hospitalisation

Incremental costs of MDT – lower by US$564 (£350) per person

Morbidity –better for MDT group

Mortality – not measured

Cost per QALY: not calculated

Williams et al., 1987, [44] USA

internists and family physicians with special expertise in geriatrics, psychiatrists, nurses, social workers, nutritionists

Geriatric patients; treatment = 58, controls = 59

RCT; cost-consequences analysis

Care by 1 internist

Functional status, institutional placement at 12 months

Hospitalisation, nursing home, home aid, transportation, GP visit, day centre, visits by various health professionals, meals-on-wheels, nurse & homemaker hours

Incremental costs of MDT – equivalent

Morbidity – equivalent

Mortality – not measured

Cost per QALY: not calculated

Kominski et al., 2001, [39] USA

Nurses, psychiatrists, psychologists, social workers, geriatricians, nutritionists, pharmacists

Geriatric patients; treatment = 814, usual care = 873

RCT; cost-consequences analysis

Usual care i.e. no MDT

36-item Health Survey Short Form (SF-36), Mental Health Inventory (MHI) at 12 months

Inpatient, ambulatory care clinic

Incremental costs of MDT – equivalent

Morbidity – equivalent

Mortality – not measured

Cost per QALY: not calculated

Pope et al., 2011, [40] Ireland

Consultant geriatrician, specialist registrar in geriatric medicine, pharmacists, nurse practitioners

Geriatric patients; treatment = 110, control = 115

RCT; cost-consequences analysis

Regular assessment i.e. no MDT

Mortality, Barthel Index, Abbreviated Mental Test Score (AMTS) at 6 months

Medical review, medication, acute hospital transfer

Incremental costs of MDT – higher by £510 per person

Morbidity – equivalent

Mortality – equivalent

Cost per QALY: not calculated

Heart failure care

Capomolla et al., 2002, [32] Italy

cardiologist, nurses, physiotherapists; part-time participation of dietician, psychologist, social assistant

Heart failure; treatment =112; control = 122

RCT; cost-utility analysis

Usual care by cardiologist

Death, QALY at 12 months

Pharmacologic, care management

Incremental costs of MDT – lower by US$10,768 (£6,688) per person

Morbidity – better for the MDT group

Mortality – lower for MDT group

Cost per QALY: US$1,068 (£663)

Kasper et al., 2002, [38] USA

Telephone nurse co-ordinator, CHF nurse, CHF cardiologist, patient’s primary physician

heart failure; treatment = 102, control = 98

RCT; cost-consequences analysis

Care provided by GP only

Death, quality of life (QoL) at 6 months

Personnel, inpatient, outpatient pharmacy, supplies

Incremental costs of MDT – equivalent

Morbidity – better for the MDT group

Mortality – equivalent

Cost per QALY: not calculated

Terminal/critical care

Rabow et al., 2004, [41] USA

Social worker, nurse, chaplain, pharmacist, psychologist, art therapist, volunteer coordinator, physician

Life limiting diseases such as cancer, advanced COPD, or advanced CHF; treatment = 50, control = 40

RCT; cost-consequences analysis

Usual care i.e. no MDT

Physical functioning and symptoms, psychological, spiritual well-being at 6 months and 12 months

Office visits, emergency department visits, hospital stays

Incremental costs of MDT - equivalent

Morbidity – better for MDT group

Mortality – not calculated

Cost per QALY: not calculated

Gade et al., 2008, [36] USA

Palliative care physician, nurse, hospital social worker and chaplain

A range of life-limiting diseases such as COPD, stroke, cancer; treatment = 280, control = 237

RCT; cost-consequences analysis

Usual care i.e. no MDT

Symptom severity, quality of life and survival at 6 months

Hospitalisation, pharmacologic, study

Incremental costs of MDT – lower by US$4,855 (£3,016) per patient

Morbidity – equivalent

Mortality – equivalent

Cost per QALY: not calculated

Rheumatoid arthritis care, stroke care, dementia care

Van den Hout et al., 2003, [43] The Netherlands

Nurse, rheumatologist occupational therapist, physical therapist, social worker.

Rheumatoid arthritis; treatment = 71 (inpatient MDT), 68 (outpatient MDT) control = 71

RCT; cost-consequences analysis

Usual care i.e. no MDT

Functional status, quality of life at 6, 12, 26, 52, and 104 weeks

Hospitalisations, personnel, home nursing care, other health professionals drugs, and appliances, out of pocket, home care informal care, paid and unpaid labour

Incremental costs of MDT –higher by €5,160 to €10,876 (£4,230 to £8,915) per person

Morbidity – equivalent

Mortality – not measured

Cost per QALY: not calculated

Yagura et al., 2005, [46] Japan

Physicians, nurses, physical therapists, occupational therapists, speech therapists, clinical psychologists, social worker

Stroke; treatment = 91, control = 87

RCT; cost-consequences analysis

Usual care i.e. no MDT

Functional status, impairment status (duration of measurement not stated)

Hospitalisation

Incremental costs of MDT –equivalent

Morbidity – equivalent

Mortality – not measured

Cost per QALY: not calculated

Wolfs et al., 2009, [45] The Netherlands

Old age psychiatry, geriatric medicine, neuropsychology, physiotherapy, occupational therapy, geriatric nursing and mental health nursing

Patients suspected of having dementia or a cognitive disorder; treatment = 131, control = 88

RCT; cost-utility analysis

Usual care i.e. no MDT

QALYs, cognition and behavioural problems at 6 months and 12 months

Medical, informal care, out-of-pocket

Incremental costs of MDT – higher by €65 (£53) per person

Morbidity – better for MDT group

Mortality – not measured

Cost per QALY: €1,267 (£1,039)

Other study designs assessing cost-effectiveness of MDTs in non-cancer care

Timpka et al., 1997, [42] Sweden

Part-time physicians, psychologist, social workers

Patients with chronic minor diseases and long-term absence from working life; 239

Cohort; cost-benefit analysis

baseline characteristics before start of programme

Vocational activity, benefits to society at 12 months and 5 years

Programme, indirect

Costs – 30,000 SEK (£2,852) per person

Benefits – 1.25 million SEK (£117,500) per person

Cost-benefit ratio – 4.9

Carling et al., 2003, [33] USA

Clinical pharmacist, infectious diseases physician

Adults receiving parenteral 3rd generation cephalosporins, aztreonam, parenteral fluoroquinolones, or imipenem; sample size not specified

B&A; cost-consequences analysis

Before MDT implemented

Incidence of nosocomial infections per 1000 patient-days

Medication

Incremental costs of MDT – lower by US$200,000 to US$250,000 per year (£124,224 to £155,280)

Morbidity – better for MDT group

Mortality – not measured

Cost per QALY: not calculated

Studies assessing cost-effectiveness of MDT in cancer care

Fader et al., 1998, [35] USA

specialists in dermatology; surgical, medical, & radiation oncology; plastic & dermatologic surgery; otorhinolaryngology; obstetrics/gynecology; ophthalmology, dermatopathology; nuclear medicine; and social work

Melanoma; treatment = 104, control = 104

Cohort; cost-consequences analysis

Usual care i.e. no MDT

Surgical morbidity at 1 month, survival at 5 years

Diagnosis and initial management

Incremental costs of MDT – lower by US$1,595 (£991) per person

Morbidity – equivalent

Mortality – equivalent

Cost per QALY: not calculated

Hagiwara et al., 2011, [37] Japan

Hemato-oncologist, nurse, dietitian, pharmacist

Hematologic malignancies; Before – 67, After – 102

B&A; cost-consequences analysis

No MDT

Number of adverse events, death (duration of measurement not stated)

Parenteral nutrition, antibiotics, food and nutritional supplement, MDT personnel

Incremental costs of MDT – lower by 403,600 yen (£3,058) per person

Morbidity – better for MDT group

Mortality – equivalent

       

Cost per QALY: not calculated

  1. B&A before and after, CHF chronic heart failure, RCT randomised controlled trial.