Objective: We aimed to assess the cost-effectiveness of adding specialized nursing care to usual care compared with usual care alone in people with Parkinson’s disease (PD).

Background: Insufficient evidence on the cost-effectiveness of Parkinson’s disease nurse specialist (PDNS) care has led to incomplete implementation and inequal access to PDNS care.

Method: The Cost-effectiveness of Nursing Interventions for Patients With PD (NICE-PD) study was an 18-month, single-blind, randomized controlled clinical trial in 11 community hospitals in the Netherlands. We included people with PD and their caregivers in all disease stages who had not been treated by a PDNS over the past 2 years. Participants were randomly assigned (1:1) to the intervention group or control group. Assessors were unaware of group assignment. Two co-primary outcome measures were selected: quality of life (PDQ-39) and severity of motor symptoms (MDS-UPDRS part III). The economic evaluation investigated the value for money of full implementation of PDNS care from a healthcare and societal perspective. Analyses were performed according to the intention-to-treat principle using a linear mixed effects model. The trial was registered in Clinical Trials (NCT03830190).

Results: 242 participants were randomly assigned to the intervention group (n=119) or control group (n=123). A total of 126 caregivers participated (n= 65 in the intervention group; n= 61 in the control group). At 18-months, there was a between-group difference of -1.92 points on the PDQ-39 (95% CI -4.31 to 0.46; p=0.11) and -1.24 points on the MDS-UPDRS part III (95% CI -3.71 to 1.24; p=0.33), both in favor of the intervention group. The pre-planned subgroup analysis showed significant improvement in quality of life for a diagnosis made < 5 years ago in favor of the intervention group (-3.30 points; 95% CI -6.03 to -0.58; p=0.018). The PDNS intervention resulted in small, but non-significant effects in the medical domain and equal costs in the societal domain. At a value of €80,000 per quality-adjusted life-year measured by the EuroQoL-5D, the probability of the PDNS intervention being cost-effective was 70%.

Conclusion: While PDNS care did not lead to significant effects on quality of life and motor symptoms, adding PDNS care to usual care did not increase costs. Results of the subgroup analysis warrant further analysis of the effects of PDNS care in early disease stages.

Trial profile

Baseline demographics of participants

Co-primary outcome measures

Results of secondary outcome measures

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-nice-pd-trial-cost-effectiveness-of-specialized-nursing-interventions-for-people-with-parkinsons-disease/