A Systematic Review of Economic Evaluations in Clinical Nursing Practices

Background. The misallocation of scarce healthcare resources globally raises concerns regarding the underuse of high-value care and the overuse of low-value care. Economic evaluations can help policy makers determine whether an intervention presents a better value for money and desirable clinical benefits, thus realizing value-based care. Aim. We aimed to conduct a systematic review of the economic evaluations of clinical nursing practices to advance knowledge on value-based care. Methods. A systematic review was conducted using MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, NHS Economic Evaluation Database, Health Technology Assessment, and Tufts CEA Registry for full economic evaluations of clinical nursing practices from January 2013 to January 2023. Outcomes were incremental cost-effectiveness ratios, incremental cost-utility ratios, incremental cost-benefit ratios, incremental net benefit, and the differences in costs for cost-minimization studies. Methodological quality was evaluated using the Consensus Health Economic Criteria–extended checklist. Results were synthesized using permutation matrices for all studies. The protocol was registered with PROSPERO (CRD42023415918). Results. Thirty-five studies were included in this review, with 27 studies categorized as good methodological quality and 8 as moderate quality. Clinical nursing practices were dominant (i.e., more effective and less costly) in 19 studies, potentially cost-effective depending on willingness-to-pay thresholds in 15 studies, and were dominated (i.e., less effective and more costly) in 1 study. Conclusion. Our study advanced knowledge on value-based care for clinical nursing practices. Results suggest that most clinical nursing practices studied may be clearly economically favourable or potentially favourable. Implications for Nursing Management. The results of this review provide valuable insights into value-based care in nursing and facilitate the decision-making of healthcare policymakers regarding health resource allocation to achieve value-based care.