在初级保健中，针对慢性阻塞性肺疾病的结构化教育肺康复计划的成本效益：PRINCE 集群随机试验。
The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial.
机构信息
School of Business and Economics, NUI Galway, Ireland.
出版信息
BMJ Open. 2013 Nov 25;3(11):e003479. doi: 10.1136/bmjopen-2013-003479.
OBJECTIVE
To assess the cost-effectiveness of a structured education pulmonary rehabilitation programme (SEPRP) for chronic obstructive pulmonary disease (COPD) relative to usual practice in primary care. The programme consisted of group-based sessions delivered jointly by practice nurses and physiotherapists over 8 weeks.
DESIGN
Cost-effectiveness and cost-utility analysis alongside a cluster randomised controlled trial.
SETTING
32 general practices in Ireland.
PARTICIPANTS
350 adults with COPD, 69% of whom were moderately affected.
INTERVENTIONS
Intervention arm (n=178) received a 2 h group-based SEPRP session per week over 8 weeks delivered jointly by a practice nurse and physiotherapist at the practice surgery or nearby venue. The control arm (n=172) received the usual practice in primary care.
MAIN OUTCOME MEASURES
Incremental costs, Chronic Respiratory Questionnaire (CRQ) scores, quality-adjusted life years (QALYs) gained estimated using the generic EQ5D instrument, and expected cost-effectiveness at 22 weeks trial follow-up.
RESULTS
The intervention was associated with an increase of €944 (95% CIs 489 to 1400) in mean healthcare cost and €261 (95% CIs 226 to 296) in mean patient cost. The intervention was associated with a mean improvement of 1.11 (95% CIs 0.35 to 1.87) in CRQ Total score and 0.002 (95% CIs -0.006 to 0.011) in QALYs gained. These translated into incremental cost-effectiveness ratios of €850 per unit increase in CRQ Total score and €472 000 per additional QALY gained. The probability of the intervention being cost-effective at respective threshold values of €5000, €15 000, €25 000, €35 000 and €45 000 was 0.980, 0.992, 0.994, 0.994 and 0.994 in the CRQ Total score analysis compared to 0.000, 0.001, 0.001, 0.003 and 0.007 in the QALYs gained analysis.
CONCLUSIONS
While analysis suggests that SEPRP was cost-effective if society is willing to pay at least €850 per one-point increase in disease-specific CRQ, no evidence exists when effectiveness was measured in QALYS gained.
TRIAL REGISTRATION
Current Controlled Trials ISRCTN52 403 063.
目的
评估针对慢性阻塞性肺疾病（COPD）的结构化教育肺康复计划（SEPRP）在初级保健中相对于常规实践的成本效益。该计划由实践护士和物理治疗师联合在 8 周内进行基于小组的课程。
设计
成本效益和成本效用分析与集群随机对照试验相结合。
地点
爱尔兰的 32 家普通诊所。
参与者
350 名 COPD 成人，其中 69%病情中度。
干预
干预组（n=178）每周接受一次 2 小时的基于小组的 SEPRP 课程，由实践护士和物理治疗师在实践手术或附近场所共同提供。对照组（n=172）接受初级保健中的常规护理。
主要观察指标
在 22 周的试验随访时，增量成本、慢性呼吸系统问卷（CRQ）评分、使用通用 EQ5D 工具估计的质量调整生命年（QALYs）和预期的成本效益。
结果
干预组的医疗保健费用平均增加 944 欧元（95%CI 489 至 1400），患者费用平均增加 261 欧元（95%CI 226 至 296）。干预组的 CRQ 总评分平均提高了 1.11（95%CI 0.35 至 1.87），QALYs 增加了 0.002（95%CI -0.006 至 0.011）。这转化为 CRQ 总评分每增加一个单位的增量成本效益比为 850 欧元，每增加一个 QALY 的成本效益比为 472000 欧元。如果社会愿意为每一点疾病特异性 CRQ 增加支付至少 850 欧元，那么在 CRQ 总评分分析中，干预措施的成本效益为 0.980，在 QALYs 增加分析中，成本效益为 0.000、0.001、0.001、0.003 和 0.007。
结论
虽然分析表明，如果社会愿意为每一点疾病特异性 CRQ 增加支付至少 850 欧元，那么 SEPRP 具有成本效益，但在以 QALYs 增加衡量有效性时，尚无证据表明这一点。
试验注册
当前对照试验 ISRCTN52403063。
Zotero 插件