Claes Neree, Moeremans Karen, Frank Buntinx, Jef Arnout, Jos Vermylen, Herman Van Loon, Lieven Annemans
Department of General Practice, Catholic University Leuven, Leuven, Belgium.
Value Health. 2006 Nov-Dec;9(6):369-76. doi: 10.1111/j.1524-4733.2006.00129.x.
A clinical trial, "Belgian Improvement Study on Oral Anticoagulation Therapy (BISOAT)," significantly improved the quality after implementing four different quality-improving interventions in four randomly divided groups of general practitioners (GPs). The quality-improving interventions consisted of multifaceted education with or without feedback reports on their performance, international normalized ratio (INR) testing by the GP with a CoaguChek device or computer-assisted advice for adapting oral anticoagulation therapy. The quality improvement in INR control versus baseline was similar in the four groups. The aim of the current study was to calculate the cost-effectiveness and influencing factors of the four quality-improving interventions compared with usual care.
Activity-based costing techniques with questionnaires were used to determine the global costs per patient per month in the different intervention groups. Effectiveness data were obtained from the BISOAT study. Cost-effectiveness was expressed as cost per additional day within a 0.5 range from INR target.
The one-time cost of multifaceted education was 49,997 euro for the whole study. Monthly continuous costs per intervention ranged between 37 euro and 54 euro per patient. Using the CoaguChek in combination with the multifaceted education was associated with net savings and quality improvement, hence dominated usual care. Sensitivity analyses showed improved cost-effectiveness with extended duration and with increased program size.
Implementation of the combination multifaceted education with the use of the CoaguChek is a cost-effective new organizational model of oral anticoagulation management in general practice.
一项名为“比利时口服抗凝治疗改善研究（BISOAT）”的临床试验，在将全科医生（GP）随机分为四组后，通过实施四种不同的质量改进干预措施，显著提高了质量。质量改进干预措施包括多方面教育（有或没有关于其表现的反馈报告）、全科医生使用CoaguChek设备进行国际标准化比值（INR）检测或计算机辅助建议以调整口服抗凝治疗。四组中INR控制相对于基线的质量改善情况相似。本研究的目的是计算与常规治疗相比，这四种质量改进干预措施的成本效益和影响因素。
采用基于活动的成本核算技术和问卷调查来确定不同干预组中每位患者每月的总体成本。有效性数据来自BISOAT研究。成本效益表示为INR目标值上下0.5范围内每增加一天的成本。
整个研究中多方面教育的一次性成本为49,997欧元。每种干预措施的每月持续成本为每位患者37欧元至54欧元。将CoaguChek与多方面教育结合使用可带来净节省和质量改善，因此优于常规治疗。敏感性分析表明，随着持续时间延长和项目规模扩大，成本效益有所提高。
在全科医疗中，实施多方面教育与使用CoaguChek相结合是一种具有成本效益的口服抗凝管理新组织模式。
