Work

Cost-effectiveness of nurse-led home monitoring of serum urate for gout patients starting with urate-lowering therapy in secondary care: a modeling study

Year: 2025

Type: article

Abstract: OBJECTIVES: To assess the cost-effectiveness of nurse-led home monitoring of serum urate (SU) versus usual care for gout patients starting urate-lowering therapy (ULT) in a secondary care setting. Additionally, the intervention's impact on nurse and rheumatologist time investment was evaluated. METHODS: A cost-effectiveness modeling study was conducted from a societal perspective. Home monitoring involved rheumatology nurses remotely supporting patients with ULT dose adjustments according to treat-to-target (T2T), while patients conducted SU testing at home. Usual care entailed hospital-based SU monitoring with rheumatologist visits also following the T2T approach. A decision tree (6-month period) and a Markov model (18 months) were employed to simulate a two-year timeframe. Costs included medications, provider time, laboratory/home testing expenses, travel, productivity losses, and gout flare-related care. Health outcomes were measured in Quality-Adjusted Life Years (QALYs). Cost-effectiveness was determined via probabilistic sensitivity analyses using a €20,000 per QALY willingness-to-pay threshold. RESULTS: Home monitoring proved cost-effective, yielding a mean incremental net monetary benefit (iNMB) of €91.43 (credible interval (CI): -56.49 to 274.09). QALYs changed marginally from 1.455 (CI: 1.389 to 1.517) under usual care to 1.459 (CI: 1.391 to 1.523) with home monitoring over two years. Rheumatologist time was reduced by 41 min (CI: -116 to 11), though nurses spent an additional 52 min (CI: 4 to 143). CONCLUSION: This modeling study demonstrates that nurse-led home monitoring of serum urate levels in gout patients starting ULT is likely to be cost-effective compared to usual secondary gout care.

Source: Seminars in Arthritis and Rheumatism

DOI: 10.1016/j.semarthrit.2025.152782