心肌梗死后患者的冠心病二级预防项目的成本效益：一项随机对照试验（ProActive Heart）的结果。
Cost-effectiveness of a coronary heart disease secondary prevention program in patients with myocardial infarction: results from a randomised controlled trial (ProActive Heart).
出版信息
BMC Cardiovasc Disord. 2013 May 1;13:33. doi: 10.1186/1471-2261-13-33.
BACKGROUND
Participation in coronary heart disease (CHD) secondary prevention programs is low. Telephone-delivered CHD secondary prevention programs may overcome the treatment gap. The telephone-based health coaching ProActive Heart trial intervention has previously been shown to be effective for improving health-related quality of life, physical activity, body mass index, diet, alcohol intake and anxiety. As a secondary aim, the current study evaluated the cost-effectiveness of the ProActive Heart intervention compared to usual care.
METHODS
430 adult myocardial infarction patients were randomised to a six-month CHD secondary prevention 'health coaching' intervention or 'usual care' control group. Primary outcome variables were health-related quality of life (SF-36) and physical activity (Active Australia Survey). Data were collected at baseline, six-months (post-intervention) and 12 months (six-months post-intervention completion) for longer term effects. Cost-effectiveness data [health utility (SF-6D) and health care utilisation] were collected using self-reported (general practitioner, specialist, other health professionals, health services, and medication) and claims data (hospitalisation rates). Intervention effects are presented as mean differences (95% CI), p-value.
RESULTS
Improvements in health status (SF-6D) were observed in both groups, with no significant difference between the groups at six [0.012 (-0.016, 0.041), p = 0.372] or 12 months [0.011 (-0.028, 0.051) p = 0.738]. Patients in the health coaching group were significantly more likely to be admitted to hospital due to causes unrelated to cardiovascular disease (p = 0.042). The overall cost for the health coaching group was higher ($10,574 vs. $8,534, p = 0.021), mainly due to higher hospitalisation (both CHD and non-CHD) costs ($6,841 vs. $4,984, p = 0.036). The incremental cost-effectiveness ratio was $85,423 per QALY.
CONCLUSIONS
There was no intervention effect measured using the SF-36/SF-6D and ProActive Heart resulted in significantly increased costs. The cost per QALY gained from ProActive Heart was high and above acceptable limits compared to usual care.
背景
参与冠心病（CHD）二级预防计划的人数较少。电话提供的 CHD 二级预防计划可能会克服治疗差距。基于电话的健康辅导 ProActive Heart 试验干预措施此前已被证明可有效改善健康相关生活质量、身体活动、体重指数、饮食、饮酒量和焦虑。作为次要目标，本研究评估了与常规护理相比，ProActive Heart 干预措施的成本效益。
方法
430 名成年心肌梗死患者被随机分配至为期六个月的 CHD 二级预防“健康辅导”干预组或“常规护理”对照组。主要结局变量为健康相关生活质量（SF-36）和身体活动（澳大利亚活动调查）。基线、六个月（干预后）和 12 个月（干预完成后六个月）收集数据，以评估长期效果。使用自我报告（全科医生、专科医生、其他健康专业人员、卫生服务和药物）和索赔数据（住院率）收集成本效益数据（健康效用（SF-6D）和卫生保健利用情况）。干预效果以平均值差异（95%CI）和 p 值表示。
结果
两组的健康状况（SF-6D）均有所改善，两组之间在六个月[0.012（-0.016，0.041），p=0.372]或 12 个月[0.011（-0.028，0.051），p=0.738]时均无显著差异。健康辅导组的患者因与心血管疾病无关的原因（p=0.042）而更有可能住院。健康辅导组的总体费用更高（$10,574 比$8,534，p=0.021），主要是由于更高的住院（包括 CHD 和非 CHD）费用（$6,841 比$4,984，p=0.036）。增量成本效益比为每获得一个质量调整生命年（QALY）需花费$85,423。
结论
使用 SF-36/SF-6D 测量未发现干预效果，ProActive Heart 导致成本显著增加。与常规护理相比，ProActive Heart 每获得一个 QALY 的成本效益比高且超出可接受范围。
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