Round Jeff, Leurent Baptiste, Jones Louise
Marie Curie Palliative Care Research Unit, University College London, London, UK.
University College London Comprehensive Clinical Trials Unit, University College London, Gower Street, London, WC1E 6BT, UK.
BMC Health Serv Res. 2014 Nov 19;14:558. doi: 10.1186/s12913-014-0558-5.
We conducted a wait-list control randomised trial of an outpatient rehabilitation service for people living with and beyond cancer, delivered in a hospice day care unit. We report the results of an economic evaluation undertaken using the trial data.
Forty-one participants were recruited into the study. A within-trial stochastic cost-utility analysis was undertaken using Monte-Carlo simulation. The outcome measure for the economic evaluation was quality adjusted life years (QALYs). Costs were measured from the perspective of the NHS and personal social services. Uncertainty in the observed data was captured through probabilistic sensitivity analysis. Scenario analysis was conducted to explore the effects of changing the way QALYs were estimated and adjusting for baseline difference in the population. We also explore assumptions about the length of treatment benefit being maintained.
The incremental cost-effectiveness ratio (ICER) for the base-case analysis was £14,231 per QALY. When QALYs were assumed to change linearly over time, this increased to £20,514 per QALY at three months. Adjusting the estimate of QALYs to account for differences in the population at baseline increased the ICER to £94,748 per QALY at three months. Increasing the assumed length of treatment benefit led to reduced ICERs in all scenarios.
Although the intervention is likely to be cost-effective in some circumstances, there is considerable uncertainty surrounding the decision to implement the service. Further research, informed by a formal value of information analysis, would reduce this uncertainty.
我们在一家临终关怀日间护理机构，针对癌症患者及康复期患者开展了一项门诊康复服务的等候名单对照随机试验。我们报告了利用试验数据进行的经济评估结果。
41名参与者被纳入研究。采用蒙特卡洛模拟进行了试验内随机成本效用分析。经济评估的结果指标是质量调整生命年（QALYs）。成本从英国国家医疗服务体系（NHS）和个人社会服务的角度进行衡量。通过概率敏感性分析捕捉观测数据中的不确定性。进行情景分析以探讨改变QALYs估计方法以及调整人群基线差异的影响。我们还探讨了关于治疗益处持续时间的假设。
基础案例分析的增量成本效益比（ICER）为每QALY 14,231英镑。假设QALYs随时间呈线性变化，三个月时该比值增至每QALY 20,514英镑。调整QALYs估计值以考虑基线人群差异后，三个月时ICER增至每QALY 94,748英镑。延长假设的治疗益处持续时间会导致所有情景下的ICER降低。
尽管该干预措施在某些情况下可能具有成本效益，但在决定实施该服务方面仍存在相当大的不确定性。通过正式的信息价值分析进行的进一步研究将减少这种不确定性。
