Radboud university medical center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, The Netherlands.
Radboud university medical center, Department of Health Evidence, Nijmegen, The Netherlands.
Mov Disord. 2015 Jul;30(8):1059-67. doi: 10.1002/mds.26217. Epub 2015 Apr 8.
A large randomized clinical trial (the Occupational Therapy in Parkinson's Disease [OTiP] study) recently demonstrated that home-based occupational therapy improves perceived performance in daily activities of people with Parkinson's disease (PD). The aim of the current study was to evaluate the cost-effectiveness of this intervention.
We performed an economic evaluation over a 6-month period for both arms of the OTiP study. Participants were 191 community-dwelling PD patients and 180 primary caregivers. The intervention group (n = 124 patients) received 10 weeks of home-based occupational therapy; the control group (n = 67 patients) received usual care (no occupational therapy). Costs were assessed from a societal perspective including healthcare use, absence from work, informal care, and intervention costs. Health utilities were evaluated using EuroQol-5d. We estimated cost differences and cost utility using linear mixed models and presented the net monetary benefit at different values for willingness to pay per quality-adjusted life-year gained.
In our primary analysis, we excluded informal care hours because of substantial missing data for this item. The estimated mean total costs for the intervention group compared with controls were €125 lower for patients, €29 lower for caregivers, and €122 higher for patient-caregiver pairs (differences not significant). At a value of €40,000 per quality-adjusted life-year gained (reported threshold for PD), the net monetary benefit of the intervention per patient was €305 (P = 0.74), per caregiver €866 (P = 0.01) and per patient-caregiver pair €845 (P = 0.24).
In conclusion, occupational therapy did not significantly impact on total costs compared with usual care. Positive cost-effectiveness of the intervention was only significant for caregivers.
一项大型随机临床试验（职业治疗帕金森病研究[OTiP]）最近表明，家庭为基础的职业治疗可改善帕金森病患者日常活动的感知表现。本研究旨在评估该干预措施的成本效益。
我们对 OTiP 研究的两个组进行了为期 6 个月的经济评估。参与者包括 191 名居住在社区的帕金森病患者和 180 名主要护理人员。干预组（n=124 名患者）接受了 10 周的家庭为基础的职业治疗；对照组（n=67 名患者）接受了常规护理（无职业治疗）。从社会角度评估了成本，包括医疗保健的使用、缺勤、非正式护理和干预成本。使用 EuroQol-5d 评估健康效用。我们使用线性混合模型估计了成本差异和成本效用，并在不同的意愿支付意愿支付金额下，展示了获得每一个质量调整生命年的净货币收益。
在我们的主要分析中，由于该项目的大量缺失数据，我们排除了非正式护理时间。与对照组相比，干预组的估计平均总费用为患者低 125 欧元，护理人员低 29 欧元，患者-护理人员低 122 欧元（差异无统计学意义）。当每获得一个质量调整生命年的意愿支付金额为 40000 欧元（报道的帕金森病阈值）时，干预对每位患者的净货币收益为 305 欧元（P=0.74），对每位护理人员为 866 欧元（P=0.01），对每位患者-护理人员为 845 欧元（P=0.24）。
总之，与常规护理相比，职业治疗对总费用没有显著影响。干预对护理人员的成本效益呈阳性。
