Duru O Kenrik, Ettner Susan L, Vassar Stefanie D, Chodosh Joshua, Vickrey Barbara G
Department of Medicine, University of California, Los Angeles, Los Angeles, CA 90024, USA.
Am J Manag Care. 2009 Aug;15(8):521-8.
To calculate intervention costs and the potential cost offset of a care management intervention that substantially improved the quality of dementia care.
From both a payer perspective and a social planner perspective, we analyzed data from a cluster randomized controlled trial (RCT) evaluating this intervention versus usual care. The RCT included 408 pairs of older adults with dementia and their caregivers. Caregivers were surveyed at baseline, at 12 months, and at 18 months to assess patient healthcare utilization and out-of-pocket costs.
We calculated fixed and per-patient intervention costs from RCT records. We combined the monthly per-patient costs of healthcare services, informal caregiving, and out-of-pocket costs, and we conducted multivariate analyses comparing this sum (potential cost offset) for intervention versus usual care patients. Covariates included patient age, sex, and baseline costs. We limited the main analysis to patients who survived until the 12-month survey or the 18-month survey.
The intervention required a start-up cost of $70,256 and mean intervention per-patient per month costs of $118. There were no significant differences in the mean monthly cost of healthcare and caregiving services for intervention versus usual care patients using the societal perspective (difference of -$555 per month, P = .28) or the payer perspective (difference of -$219 per month [including nursing home costs], P = .55; difference of -$256 per month [excluding nursing home costs], P = .47).
Although this analysis of a dementia care management intervention did not demonstrate a significant cost offset, the intervention may represent a worthwhile approach to improving the quality of care and health outcomes for patients with dementia and their caregivers.
计算一项显著改善痴呆症护理质量的护理管理干预措施的干预成本及潜在成本抵消情况。
从支付方和社会规划者的角度，我们分析了一项整群随机对照试验（RCT）的数据，该试验比较了这种干预措施与常规护理。该RCT纳入了408对患有痴呆症的老年人及其护理人员。在基线、12个月和18个月时对护理人员进行调查，以评估患者的医疗保健利用率和自付费用。
我们根据RCT记录计算固定成本和每位患者的干预成本。我们将每位患者每月的医疗服务成本、非正式护理成本和自付费用相加，并进行多变量分析，比较干预组和常规护理组患者的这一总和（潜在成本抵消）。协变量包括患者年龄、性别和基线成本。我们将主要分析限于存活至12个月调查或18个月调查的患者。
该干预措施需要70256美元的启动成本，每位患者每月的平均干预成本为118美元。从社会角度或支付方角度来看，干预组和常规护理组患者的医疗和护理服务月平均成本没有显著差异（社会角度：每月相差 -555美元，P = 0.28；支付方角度：包括养老院成本时每月相差 -219美元，P = 0.55；不包括养老院成本时每月相差 -256美元，P = 0.47）。
尽管对痴呆症护理管理干预措施的这项分析未显示出显著的成本抵消，但该干预措施可能是提高痴呆症患者及其护理人员护理质量和健康结局的一种值得采用的方法。
