S10 Is it cost-effective to replace nurses with lay asthma educators in primary care?

IntroductionRegular review of those with asthma and support for self-management is promoted in guidelines and encouraged by the Quality Outcomes Framework. Reasons for non-implementation include lack of time and training. A large randomised controlled trial in primary care suggested that need for unscheduled health care was similar if patients were reviewed and offered self management support by a trained lay educator compared to practice nurses.1MethodsA cost-effectiveness analysis was undertaken using the trial data. The cost of delivery for the intervention incorporated training and consultations. The measure of effectiveness was frequency of unscheduled healthcare which has also been costed.ResultsOne year intention to treat data (n=418) showed that 29% (61/205) of patients in the nurse group required unscheduled healthcare (177 events) compared with 30.5% (65/213) in the lay group (178 events), that is, there was no statistical difference in effect between the groups. Assigning a cost to this measure of effectiveness (unscheduled healthcare) provides £161 for nurses and £135 for lay trainers, that is, no significant difference (mean £26, (95% CI −95.61, 146.69, p=0.679)). With regards to the costs of delivery, there was no significant difference between the two arms (mean difference £−1.61 (95% CI −6.01, 2.77, p=0.4704)). While the training costs for the lay trainers were greater than nurses (£35 vs £18, respectively, per patient, p