Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, P.O.Box 1129, 85758, Neuherberg, Germany.
Clin Res Cardiol. 2009 Dec;98(12):787-95. doi: 10.1007/s00392-009-0081-6. Epub 2009 Oct 11.
Since the late 1990 s, cost pressure has led to a growing interest in outpatient rehabilitation in Germany where predominantly inpatient rehabilitation has been provided. Taking into account the feasibility of a randomized design, the aim of this study was to compare outpatient and inpatient cardiac rehabilitation from a societal perspective.
A comprehensive cohort design was applied. Costs during rehabilitation were measured using individual documentation of the rehabilitation centers. Economic end points were quality of life (EQ-5D), and total direct and indirect costs. A propensity score approach, integrated into a simultaneous regression framework for cost and effects, was used to control for selection bias. Bootstrap analysis was applied for assessing uncertainty in cost-effectiveness.
A total of 163 patients were included in the study (112 inpatients, 51 outpatients). As randomization was chosen by only 2.5% of participants, the study had to be analyzed as an observational study. Direct costs during inpatient rehabilitation were significantly higher by 600 euro (+/-318; p < 0.001) compared to outpatient rehabilitation (2,016 euro +/- 354 euro vs. 1,416 euro +/- 315), while there was no significant difference in health-related quality of life. Over the 12-month follow-up period, adjusted costs difference in total cost was estimated at -2,895 euro (p = 0.102) and adjusted difference in effects at 0.018 quality-adjusted life years (QALYs) (n.s.) in favor of outpatient treatment.
The ratio of mean cost over mean effect difference (incremental cost-effectiveness ratio) indicates dominance of outpatient rehabilitation, but at a considerable statistical uncertainty. However, outpatient rehabilitation cannot be rejected from an economic perspective.
自 20 世纪 90 年代末以来，成本压力导致人们对德国的门诊康复治疗产生了浓厚的兴趣，而德国以前主要提供住院康复治疗。考虑到随机设计的可行性，本研究旨在从社会角度比较门诊和住院心脏康复治疗。
采用综合队列设计。使用康复中心的个体记录来测量康复期间的成本。经济终点是生活质量（EQ-5D）和总直接和间接成本。采用倾向评分方法，将其纳入成本和效果的同时回归框架中，以控制选择偏差。Bootstrap 分析用于评估成本效益的不确定性。
共有 163 名患者纳入研究（112 名住院患者，51 名门诊患者）。由于只有 2.5%的参与者选择随机分组，因此该研究必须作为观察性研究进行分析。与门诊康复治疗相比，住院康复治疗的直接费用显著高出 600 欧元（+/-318；p < 0.001）（2016 欧元 +/- 354 欧元与 1416 欧元 +/- 315 欧元），而健康相关生活质量没有显著差异。在 12 个月的随访期间，总费用调整后的成本差异估计为-2895 欧元（p = 0.102），调整后的效果差异为 0.018 个质量调整生命年（QALYs）（无统计学意义），有利于门诊治疗。
平均成本与平均效果差异的比值（增量成本效益比）表明门诊康复治疗具有优势，但存在相当大的统计不确定性。然而，从经济角度来看，不能拒绝门诊康复治疗。
