Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Value Health. 2010 Dec;13(8):915-21. doi: 10.1111/j.1524-4733.2010.00797.x. Epub 2010 Nov 23.
Specialized multidisciplinary clinics have been shown to reduce mortality in heart failure (HF). Our objective was to evaluate the cost-effectiveness of this model of care delivery.
We performed a cost-effectiveness analysis, with a 12-year time horizon, from the perspective of the Ontario Ministry of Health and Long-term Care, comparing a standard care cohort, consisting of all patients admitted to hospital with HF in 2005, to a hypothetical cohort treated in HF clinics. Survival curves describing the natural history of HF were constructed using mortality estimates from the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. Survival benefits and resource uptake associated with HF clinics were estimated from a meta-analysis of published trials. HF clinics costs were obtained by costing a representative clinic in Ontario. Health-related costs were determined through linkage to administrative databases. Outcome measures included life expectancy (years), costs (in 2008 Canadian dollars) and the incremental cost-effectiveness ratio (ICER).
HF clinics were associated with a 29% reduction in all-cause mortality (risk ratio [RR] 0.71; 95% confidence interval [CI] 0.56-0.91) but a 12% increase in hospitalizations (RR 1.12; 95% CI 0.92-1.135). The cost of care in HF clinics was $52 per 30 patient-days. Projected life-expectancy of HF clinic patients was 3.91 years, compared to 3.21 years for standard care. The 12-year cumulative cost per patient in the HF clinic group was $66,532 versus $53,638 in the standard care group. The ICER was $18,259/life-year gained.
HF clinics appear to be a cost effective way of delivering ambulatory care to HF patients.
专门的多学科诊所已被证明可以降低心力衰竭（HF）的死亡率。我们的目的是评估这种护理模式的成本效益。
我们进行了一项成本效益分析，时间范围为 12 年，从安大略省卫生部和长期护理的角度出发，将 2005 年因 HF 住院的所有患者组成的标准护理队列与假设的 HF 诊所治疗队列进行比较。使用来自增强有效心脏治疗反馈（EFFECT）研究的死亡率估计值构建描述 HF 自然史的生存曲线。HF 诊所的生存获益和资源利用情况来自对已发表试验的荟萃分析进行估算。通过对安大略省一家代表性诊所进行成本核算获得 HF 诊所的成本。通过与行政数据库进行链接确定与健康相关的成本。结果指标包括预期寿命（年）、成本（2008 年加元）和增量成本效益比（ICER）。
HF 诊所与全因死亡率降低 29%相关（风险比[RR]0.71；95%置信区间[CI]0.56-0.91），但住院率增加 12%（RR 1.12；95%CI 0.92-1.135）。HF 诊所的护理成本为每位患者每 30 天 52 美元。HF 诊所患者的预期寿命为 3.91 年，而标准护理为 3.21 年。HF 诊所组患者 12 年的累计每位患者成本为 66532 美元，而标准护理组为 53638 美元。ICER 为每增加 1 个生命年花费 18259 美元。
HF 诊所似乎是为 HF 患者提供门诊护理的一种具有成本效益的方法。
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