Department of General Practice, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
PLoS One. 2012;7(5):e37444. doi: 10.1371/journal.pone.0037444. Epub 2012 May 24.
The objective of this study was to evaluate the cost-effectiveness of a Multidisciplinary Integrated Care (MIC) model compared to Usual Care (UC) in Dutch residential homes.
The economic evaluation was conducted from a societal perspective alongside a 6 month, clustered, randomized controlled trial involving 10 Dutch residential homes. Outcome measures included a quality of care weighted sum score, functional health (COOP WONCA) and Quality Adjusted Life-Years (QALY). Missing cost and effect data were imputed using multiple imputation. Bootstrapping was used to analyze differences in costs and cost-effectiveness.
The quality of care sum score in MIC was significantly higher than in UC. The other primary outcomes showed no significant differences between the MIC and UC. The costs of providing MIC were approximately €225 per patient. Total costs were €2,061 in the MIC group and €1,656 for the UC group (mean difference €405, 95% -13; 826). The probability that the MIC was cost-effective in comparison with UC was 0.95 or more for ceiling ratios larger than €129 regarding patient related quality of care. Cost-effectiveness planes showed that the MIC model was not cost-effective compared to UC for the other outcomes.
Clinical effect differences between the groups were small but quality of care was significantly improved in the MIC group. Short term costs for MIC were higher. Future studies should focus on longer term economic and clinical effects.
Controlled-Trials.com ISRCTN11076857.
本研究旨在评估与常规护理（UC）相比，多学科综合护理（MIC）模式在荷兰养老院中的成本效益。
这项经济评估是从社会角度进行的，同时进行了一项为期 6 个月的、集群的、随机对照试验，涉及 10 家荷兰养老院。结果测量包括护理质量加权总和评分、功能健康（COOP WONCA）和质量调整生命年（QALY）。使用多重插补法对缺失的成本和效果数据进行插补。使用自举法分析成本和成本效益的差异。
MIC 的护理质量总和评分明显高于 UC。其他主要结果在 MIC 和 UC 之间没有显著差异。提供 MIC 的成本约为每位患者 225 欧元。MIC 组的总费用为 2061 欧元，UC 组为 1656 欧元（平均差异为 405 欧元，95%置信区间为-13；826）。对于患者相关的护理质量，MIC 与 UC 相比，成本效益比大于 129 欧元的上限比率的概率为 0.95 或更高。成本效益平面显示，与 UC 相比，MIC 模型在其他结果方面不具有成本效益。
组间临床效果差异较小，但 MIC 组的护理质量显著提高。MIC 的短期成本较高。未来的研究应侧重于长期的经济和临床效果。
controlled-trials.com ISRCTN8547715。
