Children’s epilepsy specialist nurse: An economic evaluation

Background: Funding was secured by the Hywel Dda University Health Board’s (HDUHB) Children’s Community Nursing Service (CCNS) enabling the appointment of specialist nurses to improve health outcomes for children and young people (CYP) with severe chronic disease. The first appointment (November 2021) was in epilepsy. By August 2023, approximately n=150 CYP residing across the region managed by HDUHB had received children’s epilepsy specialist nurse (CESN) care. This involves care planning, facilitating appropriate participation, risk assessment, school and respite care liaison, rescue medication training and telephone advice. It is timely to evaluate this provision. Our main aims were to establish the cost of the CESN intervention, assess whether it had been cost-saving, and then estimate its return on investment. Methods: The perspective of the analysis is that of the NHS health board, HDUHB. The price year was 2023-24. The study covers the period up to the end of August 2023, giving a 22-month timeframe. We used standard incremental methods for analyses. Absent data from a control group observed concurrently with the study population, comparisons were made instead to the treatment as usual (TAU) arm reported in the NICE economic evaluation of an epilepsy specialist nurse intervention. TAU does not include access to a CESN. Results: The prevalence of epilepsy in CYP in HDUHB, estimated at approximately 320 cases, is more than twice the current CESN caseload as of August 2023. Our Baseline analysis established that the CESN intervention compared against TAU contributed a total of £163,983 in cost savings to HDUHB over the 22-month timeframe of operations. This represents a return on investment to HDUHB of 45.4% pa (95%CI 16.53-70.12; p<0.05). Conclusions: Despite an underserved population and failure to meet contacting targets in NICE guidance, the CESN intervention for CYP with epilepsy has delivered cost savings to the NHS over the 22 months of operations and a positive return on investment. Continuation of the CESN intervention will not financially disadvantage HDUHB. However, if NICE guidelines are to be met further investment of resources that build the CESN provision are required.