Rizzo J A, Bogardus S T, Leo-Summers L, Williams C S, Acampora D, Inouye S K
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Med Care. 2001 Jul;39(7):740-52. doi: 10.1097/00005650-200107000-00010.
Delirium, or acute confusional state, is a common and serious occurrence among hospitalized older persons. Current estimates suggest that delirium complicates hospital stays for more than 2.3 million older persons each year, involving more than 17.5 million hospital days and accounting for more than $4 billion (1994 dollars) of Medicare expenditures. A 40% reduction was recently reported in the risk for delirium among hospitalized older persons receiving a multicomponent targeted risk factor intervention (MTI) strategy to prevent delirium, compared with subjects receiving usual hospital care.1 Before recommending that this preventive strategy be implemented in clinical practice, however, the cost implications must be thoroughly examined as well.
The present analysis performs net cost evaluations of the MTI for the prevention of delirium among hospitalized patients. Hospital charge and cost-to-charge ratio data are linked to a database of 852 subjects, who were treated with MTI or usual care. Multivariable regression methods were used to help isolate the impact of MTI on hospital costs. These results were then combined with our earlier work on the impact of the MTI on delirium prevention to assess the cost effectiveness of this intervention.
The MTI significantly reduced nonintervention costs among subjects at intermediate risk for developing delirium, but not among subjects at high risk. When MTI intervention costs were included, MTI had no significant effect on overall health care costs in the intermediate risk cohort, but raised overall costs in the high risk group.
Because the MTI prevented delirium in the intermediate risk group without raising costs, the conclusion reached is that it is a cost effective treatment option for patients at intermediate risk for developing delirium. In contrast, the results suggest that the MTI is not cost effective for subjects at high risk.
谵妄，即急性意识模糊状态，是住院老年人中常见且严重的情况。目前的估计表明，谵妄每年使超过230万老年人的住院情况变得复杂，涉及超过1750万个住院日，占医疗保险支出超过40亿美元（1994年美元）。最近报告称，与接受常规医院护理的受试者相比，接受多组分靶向危险因素干预（MTI）策略以预防谵妄的住院老年人中，谵妄风险降低了40%。然而，在建议将这种预防策略应用于临床实践之前，其成本影响也必须进行全面审查。
本分析对预防住院患者谵妄的MTI进行净成本评估。医院收费和成本收费比数据与852名接受MTI或常规护理治疗的受试者数据库相关联。使用多变量回归方法来帮助分离MTI对医院成本的影响。然后将这些结果与我们早期关于MTI对谵妄预防影响的研究相结合，以评估这种干预措施的成本效益。
MTI显著降低了发生谵妄中度风险受试者的非干预成本，但对高风险受试者没有效果。当纳入MTI干预成本时，MTI对中度风险队列的总体医疗保健成本没有显著影响，但增加了高风险组的总体成本。
由于MTI在中度风险组中预防了谵妄且未增加成本，得出的结论是，对于有发生谵妄中度风险的患者，它是一种具有成本效益的治疗选择。相比之下，结果表明MTI对高风险受试者不具有成本效益。
