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 |