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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.