Flood Chris, Mugford Miranda, Stewart Sandra, Harvey Ian, Poland Fiona, Lloyd-Smith Walter
St Bartholomew School of Nursing and Midwifery, City University, Philpot Street, London E1 2EA, UK.
Age Ageing. 2005 Jan;34(1):47-52. doi: 10.1093/ageing/afh232. Epub 2004 Nov 10.
To compare costs and outcome of occupational therapy-led assessment with social worker-led assessment of older people, in terms of their independence and quality of life.
Cost-effectiveness analysis alongside a randomised controlled trial. The analysis took viewpoints of health services and patients. The primary outcome measure for cost-effectiveness was dependency using the Community Dependency Index (CDI). Secondary outcomes included utility scores based on the EuroQoL (EQ-5D). Resource use was measured for each patient, from clinical records and from patient carer interviews at 8 months. Unit costs of health and social care resources were derived from local sources and national datasets. Cost-effectiveness was analysed using cost-effectiveness acceptability curves.
There were no differences between the two arms of the trial in terms of cost-effectiveness. There is an apparent increase in mean cost per case for the occupational therapy arm but this is not statistically significant (mean difference in cost per case 542 pounds, 95% CI 434-1,519 pounds). Mean total costs of care per participant were 4,379 pounds and 3,837 pounds for the occupational therapy and social work arms, respectively. At best the intervention would improve outcomes at a cost of 14,000 pounds per quality-adjusted life year (QALY). The probability of such an outcome was <50%.
From a policy perspective, the lack of difference in clinical and cost-effectiveness means that either a social work or an occupational therapy service is successful in making care assessments that enable an older person to remain in their own home.
比较由职业治疗师主导的评估与由社会工作者主导的评估对老年人独立性和生活质量的成本及结果。
成本效益分析与随机对照试验相结合。该分析采用了卫生服务和患者的视角。成本效益的主要结局指标是使用社区依赖指数（CDI）来衡量的依赖性。次要结局包括基于欧洲五维度健康量表（EQ - 5D）的效用得分。通过临床记录和在8个月时对患者护理人员的访谈来测量每位患者的资源使用情况。卫生和社会护理资源的单位成本来自当地资料和国家数据集。使用成本效益可接受性曲线分析成本效益。
在成本效益方面，试验的两组之间没有差异。职业治疗组的每例平均成本有明显增加，但无统计学意义（每例成本的平均差异为542英镑，95%置信区间为434 - 1519英镑）。职业治疗组和社会工作组每位参与者的护理总平均成本分别为4379英镑和3837英镑。干预措施最多以每质量调整生命年（QALY）14000英镑的成本改善结局。这种结果的概率小于50%。
从政策角度来看，临床和成本效益方面缺乏差异意味着社会工作服务或职业治疗服务在进行护理评估以使老年人能够居家养老方面都是成功的。
