Melis René J F, Adang Eddy, Teerenstra Steven, van Eijken Monique I J, Wimo Anders, van Achterberg Theo, van de Lisdonk Eloy H, Rikkert Marcel G M Olde
Radboud University Nijmegen Medical Centre, Department of Geriatric Medicine, Nijmegen, The Netherlands.
J Gerontol A Biol Sci Med Sci. 2008 Mar;63(3):275-82. doi: 10.1093/gerona/63.3.275.
There is growing interest in geriatric care for community-dwelling older people. There are, however, relatively few reports on the economics of this type of care. This article reports about the cost-effectiveness of the Dutch Geriatric Intervention Program (DGIP) compared to usual care in frail older people at 6-month follow-up from a health care system's point of view.
We conducted this economic evaluation in an observer-blind randomized controlled trial (Dutch EASYcare Study: ClinicalTrials.gov Identifier NCT00105378). Difference in treatment effect was calculated as the difference in proportions of successfully treated patients (prevented functional decline accompanied by improved well-being). Incremental treatment costs were calculated as the difference in mean total care costs. The incremental cost-effectiveness ratio (ICER) was expressed as total cost per successful treatment. Bootstrap methods were used to determine confidence intervals (CI) for these measures.
The average cost of the intervention under study (DGIP) was 998 euros (95% CI, 888-1108). The increment in total cost resulting from DGIP was a little over 761 euros (-3336 to 4687). Hospitalization and institutionalization costs were less; home care, adult day care, and meals-on-wheels costs were higher. There was a significant difference in proportions of successful treatments of 22.3% (4.3-41.4). The number needed to treat was approximately 4.7 (2.3-18.0). The ICER is 3418 euros per successful treatment (-21,458 to 45,362). The new treatment is cost-effective at a willingness-to-pay of 34,000 euros.
The results of this economic evaluation suggest that DGIP is an effective addition to primary care for frail older people at a reasonable cost.
社区老年人的老年护理越来越受到关注。然而，关于此类护理的经济学报道相对较少。本文从医疗保健系统的角度报告了荷兰老年干预计划（DGIP）与虚弱老年人常规护理相比在6个月随访时的成本效益。
我们在一项观察者盲法随机对照试验（荷兰EASYcare研究：ClinicalTrials.gov标识符NCT00105378）中进行了这项经济评估。治疗效果差异计算为成功治疗患者比例的差异（预防功能下降并伴有幸福感改善）。增量治疗成本计算为平均总护理成本的差异。增量成本效益比（ICER）表示为每次成功治疗的总成本。采用自助法确定这些指标的置信区间（CI）。
所研究干预措施（DGIP）的平均成本为998欧元（95%CI，888 - 1108）。DGIP导致的总成本增量略高于761欧元（-3336至4687）。住院和机构化成本较低；家庭护理、成人日托和送餐成本较高。成功治疗比例存在显著差异，为22.3%（4.3 - 41.4）。所需治疗人数约为4.7（2.3 - 18.0）。ICER为每次成功治疗3418欧元（-21458至45362）。在支付意愿为34000欧元时，新治疗具有成本效益。
这项经济评估结果表明，DGIP是以合理成本为虚弱老年人提供初级护理的有效补充。
