Henderson Catherine, Knapp Martin, Fernández José-Luis, Beecham Jennifer, Hirani Shashivadan P, Beynon Michelle, Cartwright Martin, Rixon Lorna, Doll Helen, Bower Peter, Steventon Adam, Rogers Anne, Fitzpatrick Ray, Barlow James, Bardsley Martin, Newman Stanton P
Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK.
Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK King's College, London, UK.
Age Ageing. 2014 Nov;43(6):794-800. doi: 10.1093/ageing/afu067. Epub 2014 Jun 20.
to examine the costs and cost-effectiveness of 'second-generation' telecare, in addition to standard support and care that could include 'first-generation' forms of telecare, compared with standard support and care that could include 'first-generation' forms of telecare.
a pragmatic cluster-randomised controlled trial with nested economic evaluation. A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas. In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control. Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months, additional to their standard health and social care services. The control group received usual health and social care.
incremental cost per quality-adjusted life year (QALY) gained. The analyses took a health and social care perspective.
cost per additional QALY was £297,000. Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £30,000 per QALY gained was only 16%. Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £161,000 per QALY.
while QALY gain in the intervention group was similar to that for controls, social and health services costs were higher. Second-generation telecare did not appear to be a cost-effective addition to usual care, assuming a commonly accepted willingness to pay for QALYs.
ISRCTN 43002091.
除了可能包括“第一代”远程护理形式的标准支持和护理外，研究“第二代”远程护理的成本和成本效益，并与可能包括“第一代”远程护理形式的标准支持和护理进行比较。
一项带有嵌套式经济评估的实用整群随机对照试验。共有2600名有社会护理需求的人参与了在英格兰三个地方当局地区进行的基于社区的远程护理试验。在全系统示范远程护理问卷调查研究中，550名参与者被随机分配到干预组，639名参与者被分配到对照组。接受远程护理干预的参与者除了接受标准的健康和社会护理服务外，还获得了一套设备和监测服务，为期12个月。对照组接受常规的健康和社会护理。
每获得一个质量调整生命年（QALY）的增量成本。分析采用了健康和社会护理视角。
每增加一个QALY的成本为29.7万英镑。成本效益可接受性曲线表明，在每获得一个QALY愿意支付3万英镑的情况下，具有成本效益的概率仅为16%。结合设备价格和支持成本参数变化的敏感性分析得出，每QALY的成本效益比为16.1万英镑。
虽然干预组获得的QALY与对照组相似，但社会和卫生服务成本更高。假设对QALY有普遍接受的支付意愿，第二代远程护理似乎并不是常规护理的一种具有成本效益的补充。
ISRCTN 43002091。
