Published 17 March 2009, doi:10.1136/bmj.b1082
Cite this as: BMJ 2009;338:b1082

Letters

Nurse delivered endoscopy

Study authors respond to editorial

The first 150 words of the full text of this article appear below.

We wish to clarify some points raised by Norton and colleagues in their editorial accompanying our papers.1 2 3

The subtitle, stating that nurse endoscopy "is as clinically effective as that delivered by doctors, but may cost more," is inaccurate. We found doctors more cost effective because their outcomes were slightly better, even though they cost slightly more than nurses.

In the papers we summarised the main outcome measures of the trial, but more detail is given in the full report, where we describe other measures including polyp detection rates.4 The procedure duration seems long because it was timed from one extubation to the next, to reflect any activities undertaken by endoscopists between patients.

The editorial’s discussion of the threshold chosen for cost per QALY is open to misinterpretation. A threshold of £5000 does reveal a 60% probability of doctors being cost-effective, but as this threshold increases so the probability of doctors . . . [Full text of this article]

John Williams, professor of health services research1, Gerry Richardson, senior research fellow2, Karen Bloor, senior research fellow3

1 Centre for Health Information, Research and Evaluation, School of Medicine, Swansea University, Swansea SA2 8PP, 2 Centre for Health Economics and Hull York Medical School (HYMS), University of York, York, 3 Department of Health Sciences, University of York

j.g.williams@swansea.ac.uk


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