基于试验的 2 种心力衰竭护士主导疾病管理方案的经济学评价。
A trial-based economic evaluation of 2 nurse-led disease management programs in heart failure.
机构信息
Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands.
出版信息
Am Heart J. 2011 Dec;162(6):1096-104. doi: 10.1016/j.ahj.2011.09.019.
BACKGROUND
Although previously conducted meta-analyses suggest that nurse-led disease management programs in heart failure (HF) can improve patient outcomes, uncertainty regarding the cost-effectiveness of such programs remains.
METHODS
To compare the relative merits of 2 variants of a nurse-led disease management program (basic or intensive support by a nurse specialized in the management of patients with HF) against care as usual (routine follow-up by a cardiologist), a trial-based economic evaluation was conducted alongside the COACH study.
RESULTS
In terms of costs per life-year, basic support was found to dominate care as usual, whereas the incremental cost-effectiveness ratio between intensive support and basic support was found to be equal to €532,762 per life-year; in terms of costs per quality-adjusted life-year (QALY), basic support was found to dominate both care as usual and intensive support. An assessment of the uncertainty surrounding these findings showed that, at a threshold value of €20,000 per life-year/€20,000 per QALY, basic support was found to have a probability of 69/62% of being optimal against 17/30% and 14/8% for care as usual and intensive support, respectively. The results of our subgroup analysis suggest that a stratified approach based on offering basic support to patients with mild to moderate HF and intensive support to patients with severe HF would be optimal if the willingness-to-pay threshold exceeds €45,345 per life-year/€59,289 per QALY.
CONCLUSIONS
Although the differences in costs and effects among the 3 study groups were not statistically significant, from a decision-making perspective, basic support still had a relatively large probability of generating the highest health outcomes at the lowest costs. Our results also substantiated that a stratified approach based on offering basic support to patients with mild to moderate HF and intensive support to patients with severe HF could further improve health outcomes at slightly higher costs.
背景
尽管先前进行的荟萃分析表明，心力衰竭（HF）患者的护士主导的疾病管理方案可以改善患者的预后，但此类方案的成本效益仍存在不确定性。
方法
为了比较两种护士主导的疾病管理方案（基本或专门管理 HF 患者的护士提供强化支持）与常规护理（心脏病专家的常规随访）的相对优势，在 COACH 研究的同时进行了基于试验的经济评估。
结果
就生命年成本而言，基本支持被发现优于常规护理，而强化支持与基本支持之间的增量成本效益比被发现等于每生命年 532762 欧元；就质量调整生命年（QALY）成本而言，基本支持被发现优于常规护理和强化支持。对这些发现的不确定性进行评估表明，在每生命年/每 QALY 20000 欧元的阈值下，基本支持相对于常规护理和强化支持具有 69/62%的最优概率，分别为 17/30%和 14/8%。我们的亚组分析结果表明，如果支付意愿阈值超过每生命年 45345 欧元/每 QALY 59289 欧元，基于向轻度至中度 HF 患者提供基本支持和向重度 HF 患者提供强化支持的分层方法将是最优的。
结论
尽管 3 个研究组之间的成本和效果差异没有统计学意义，但从决策角度来看，基本支持在以最低成本获得最高健康结果方面仍具有相对较大的概率。我们的结果还证实，基于向轻度至中度 HF 患者提供基本支持和向重度 HF 患者提供强化支持的分层方法可以在略微增加成本的情况下进一步提高健康结果。
Zotero 插件