Methodological Issues in Nursing Research on Cost-Effectiveness Analysis

Abstract

Cost effectiveness is a recent and newly emerging approach in nursing evaluation studies. Nursing is in a unique position among health care providers to respond to these efforts and is ready to provide evidence of its cost-effectiveness because nurses has long advocated a holistic view of patient care, that means, nurses are unique position to identify the full range of costs and effects. The cumulative evidence showed that nurses provided cost-effective care that substituted for physician services in many situations and new and important services in long-term care and nursing homes. The purpose of this article is to review, critique, and synthesize research on the cost-effectiveness of nursing care from the research methodology perspective. Two major problems are apparent from this review. First, there is no uniform approach to identifying and valuing resources used in producing nursing intervention options. Second, although it is not difficult to find reports of cost savings, the cost to effect ratio was not used to evaluate the relationship between the cost and effects of alternative options. Based on my analysis, the nursing CEA literature seemed to have huge variation in methods, so that it is not easy to compare the CEA methods among studies. There are still such methodological problems as we found in the literature review. Many of the studies reviewed here would have profited from improved designs. Therefore, future cost-effectiveness analyses should include methodological progress in the context of nursing area application such as the definition and quantification of multi-attribute effectiveness measures, employment of sensitivity analysis, a concept of discount. Nurse and nurse researchers should consider cost-effectiveness questions when addressing other research questions. Because these efforts are forcing policy makers to consider the economics of nursing, nurses should demonstrate and document the value of nursing as compared to other uses of society's health care resources.