Makai Peter, Looman Willemijn, Adang Eddy, Melis René, Stolk Elly, Fabbricotti Isabelle
Department of Geriatrics, Radboud University Medical Center, Renier Postlaan 4, 6500 HB, Nijmegen, The Netherlands,
Eur J Health Econ. 2015 May;16(4):437-50. doi: 10.1007/s10198-014-0583-7. Epub 2014 Apr 24.
Economic evaluations likely undervalue the benefits of interventions in populations receiving both health and social services, such as frail elderly, by measuring only health-related quality of life. For this reason, alternative preference-based instruments have been developed for economic evaluations in the elderly, such as the ICECAP-O. The aim of this paper is twofold: (1) to evaluate the cost-effectiveness using a short run time frame for an integrated care model for frail elderly, and (2) to investigate whether using a broader measure of (capability) wellbeing in an economic evaluation leads to a different outcome in terms of cost-effectiveness. We performed univariate and multivariate analyses on costs and outcomes separately. We also performed incremental net monetary benefit regressions using quality adjusted life years (QALYs) based on the ICECAP-O and EQ-5D. In terms of QALYs as measured with the EQ-5D and the ICECAP-O, there were small and insignificant differences between the instruments, due to negligible effect size. Therefore, widespread implementation of the Walcheren integrated care model would be premature based on these results. All results suggest that, using the ICECAP-O, the intervention has a higher probability of cost-effectiveness than with the EQ-5D at the same level of WTP. In case an intervention's health and wellbeing effects are not significant, as in this study, using the ICECAP-O will not lead to a false claim of cost-effectiveness of the intervention. On the other hand, if differences in capability QALYs are meaningful and significant, the ICECAP-O may have the potential to measure broader outcomes and be more sensitive to differences between intervention and comparators.
经济评估可能低估了对同时接受健康和社会服务人群（如体弱老年人）干预措施的益处，因为这些评估仅衡量与健康相关的生活质量。因此，已开发出替代的基于偏好的工具用于老年人的经济评估，如ICECAP - O。本文的目的有两个：（1）使用短期时间框架评估针对体弱老年人的综合护理模式的成本效益，（2）研究在经济评估中使用更广泛的（能力）福祉衡量指标是否会导致成本效益方面的不同结果。我们分别对成本和结果进行了单变量和多变量分析。我们还使用基于ICECAP - O和EQ - 5D的质量调整生命年（QALY）进行了增量净货币效益回归分析。就EQ - 5D和ICECAP - O所衡量的QALY而言，由于效应量可忽略不计，两种工具之间存在微小且不显著的差异。因此，基于这些结果，过早广泛实施瓦尔赫伦综合护理模式是不合适的。所有结果表明，使用ICECAP - O时，在相同支付意愿水平下，该干预措施比使用EQ - 5D更有可能具有成本效益。在干预措施的健康和福祉影响不显著的情况下，如本研究，使用ICECAP - O不会导致对干预措施成本效益的错误认定。另一方面，如果能力QALY的差异有意义且显著，ICECAP - O可能有潜力衡量更广泛的结果，并且对干预措施与对照之间的差异更敏感。
