Lopes de Almeida J Pedro, Pinto Anabela, Pinto Susana, Ohana Benjamim, de Carvalho Mamede
Department of Physical Medicine and Rehabilitation, Santa Maria Hospital, Lisbon, Portugal.
Amyotroph Lateral Scler. 2012 Oct;13(6):533-7. doi: 10.3109/17482968.2012.703675. Epub 2012 Aug 8.
Our objective was to measure direct (hospital and NHS) and indirect (patient/caregiver) costs of following up in-home compliance to non-invasive ventilation via wireless modem. We constructed a prospective controlled trial of 40 consecutive ALS home-ventilated patients, randomly assigned according to their residence area to G1 (nearby hospital, office-based follow-up) and G2 (outside hospital area, telemetry device-based follow-up). Total NHS direct cost encompassed costs related to outpatients' visits (office and emergency room) and hospitalizations. Hospital direct costs included transportation to/from hospital, office visit per hour cost and equipment maintenance. Non-medical costs considered days of wages lost due to absenteeism. G1 included 20 patients aged 60 ± 10 years and G2 included 19 patients aged 62 ± 13 years. Results showed that no differences were found regarding clinical/demographic characteristics at admission. NHS costs showed a 55% reduction in average total costs with a statistically significant decrease of 81% in annual costs per patient in G2. Hospital costs were found to be significantly higher in G2 with regard to total costs (64% average increase) but not annual costs (7%). No statistical difference was found with regard to expenses from absenteeism. In conclusion, at the cost of an initial financial constraint to the hospital per year (non-significant), telemonitoring is cost-effective, representing major cost savings to the NHS in the order of 700 euros/patient/year.
我们的目标是测量通过无线调制解调器对家庭无创通气依从性进行随访的直接（医院和英国国家医疗服务体系，NHS）成本和间接（患者/护理人员）成本。我们对40例连续的肌萎缩侧索硬化症（ALS）家庭通气患者进行了一项前瞻性对照试验，根据他们的居住区域随机分配到G1组（附近医院，基于办公室的随访）和G2组（医院区域外，基于遥测设备的随访）。NHS的直接总成本包括与门诊就诊（办公室和急诊室）及住院相关的费用。医院直接成本包括往返医院的交通费用、每小时的门诊费用以及设备维护费用。非医疗成本考虑了因缺勤而损失的工作日工资。G1组包括20例年龄为60±10岁的患者，G2组包括19例年龄为62±13岁的患者。结果显示，入院时在临床/人口统计学特征方面未发现差异。NHS成本显示平均总成本降低了55%，G2组每名患者的年度成本在统计学上显著降低了81%。就总成本而言，G2组的医院成本显著更高（平均增加64%），但年度成本方面并非如此（增加7%）。在缺勤费用方面未发现统计学差异。总之，尽管医院每年会面临初始资金限制（不显著），但远程监测具有成本效益，可为NHS节省约700欧元/患者/年的大量成本。
