Does nursing need `the dismal science'? The case for economic evaluations in nursing

Abstract

This paper assesses the role of economic evaluation in the nursing context and reviews the problems involved in applying standard frameworks used elsewhere in health economics.

The UK literature on studies of cost-effectiveness and nursing is reviewed and, as a consequence of the gaps on the topic that were revealed, ways of approaching the issue are suggested. The question is asked whether economic evaluation in the nursing context needs to be addressed at all, following which a framework for analysis is suggested. The paucity of economic appraisals in nursing has been noted by previous authors. In the UK, the majority of these focus on specific areas of care, such as leg ulcer treatments, with more general areas, such as evaluations of case management, home versus hospital deliveries and new nursing roles, being confined to the USA literature.

Ways of approaching economic evaluation are outlined by means of a suggested framework for analysis, with a brief discussion on the complexities of measuring costs and outcomes. The final section of the paper introduces the concept of measurement of quality of nursing care into the framework and the difficult questions raised by its inclusion.

The paper concludes by suggesting that, in this time of scarce resources and the need to allocate such resources prudently, nurses could work with their colleagues in other disciplines to produce sound evidence in order to inform debate in this area.