The impact of an epilepsy nurse competency framework on the costs of supporting adults with epilepsy and intellectual disability: findings from the EpAID study.
M Pennington, H Ring, J Howlett and 14 others
PMID 31397022WHAT IT FOUND
Competency framework training, added to trial training for nurses, was linked to lower costs for adults with epilepsy and intellectual disability at 6 months, but the reduction was not significant.
It may save costs, not prove it.
Key findings
01The competency framework training, added to the 3-hour trial training received by nurses in both arms, was associated with lower costs at 6 months, but the difference was not significant at the 5% level; 82% of bootstrap replicates indicated cost saving.
02Formal accommodation costs accounted for around half of total health and social care costs, despite over a third of participants living with family; accommodation costs increased at 6 months while social support costs fell.
03Subgroup analysis suggested greater cost reductions in participants with severe or profound ID, and excluding accommodation costs or accounting for clustering did not change the non-significant result.
STILL TO COME
How it was doneWhat they found
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What it does not show
Nurses were not blinded to allocation, and participants and carers were not explicitly informed but were not formally blinded. Recruitment per site fell short of the original plan, although more sites were added. Baseline imbalances existed: the framework arm had more nurses who self-assessed as expert, more nurse prescribers and more band 8 nurses; the treatment-as-usual arm had more participants with mild or moderate ID, more non-White participants and more participants living with family. Missing data were higher at follow-up, but not more than 20% of the total. Accommodation costs were large and crudely estimated, and detailed appraisal was not done. The trial was powered for a quality-of-life outcome, not cost, so the cost analysis was insufficient to be certain the framework lowered costs. Clustering and baseline adjustment were handled in separate analyses rather than one model.
Declared interests
Dr Ring reports grants from the National Institute for Health Research (UK) during the study. Dr Pennington reports NIHR HTA grants during the study and personal fees from Merck outside the submitted work. Dr Pullen reports funding from UCB Pharma, LivaNova, Eisai, Cyberonics Europe BVBA (nowLivaNova), Sanofi and Special Products Ltd, grants from UCB Pharma outside the submitted work, and Epilepsy Action campaigns for increased access to specialist nurses.
The easy way to misread this
Do not read the 82% bootstrap result as proof that the framework saves costs. The cost reduction was not significant at the 5% level, and the trial's primary outcome was quality of life, not cost.