Baylor Scott & White Health , Temple, TX , USA.
Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M Health Science Center , College Station, TX , USA.
Front Public Health. 2015 Apr 27;3:27. doi: 10.3389/fpubh.2015.00027. eCollection 2015.
Chronic conditions are the leading cause of growing healthcare spending, disability, and death in the U.S. In the wake of national health reform, policy makers and healthcare professionals are becoming increasingly concerned in containing healthcare costs while improving quality of patient care. A basic policy question is whether the Chronic Disease Self-Management Program (CDSMP), a widely distributed evidenced-based self-managed program, can be cost-effective in managing chronic conditions while improving quality of life. Utilizing data from the National Study of CDSMP, the primary objective of the current study is to estimate cost-effectiveness of the CDSMP program among individuals with at least one chronic condition. The second objective is to determine how cost-effectiveness ratios vary by depression status. EuroQol-5D (EQ-5D) was used to measure health-related quality of life (HRQOL) of CDSMP participants, which was then converted to quality-adjusted life years (QALYs) for cost-effectiveness analysis. Participants who completed the CDSMP program experienced higher EQ-5D scores from baseline to 12-month follow-up (increased from 0.736 to 0.755; p < 0.001). The incremental cost-effectiveness ratio (ICER) ranges from $83,285 to $31,285 per QALYs, which can be comparable to the common benchmark of $50,000/QALYs. ICER by baseline depression status indicates that it will cost more per QALYs gained for those diagnosed with depression based on their Patient Health Questionnaire-8 score. However, cautions should be taken while considering this point estimate too literally because the average cost for CDSMP participants was a rough estimate and based on several simplifying assumptions. Identifying cost-effective strategies that can lower the burden of chronic disease among community-dwelling adults is critical for decision makers in allocating limited resources. Policy makers and community organizations can use this information to guide funding decisions and delivery of CDSMP programs for individuals with multiple chronic health conditions.
慢性疾病是导致美国医疗保健支出增长、残疾和死亡的主要原因。在国家卫生改革之后，政策制定者和医疗保健专业人员越来越关注控制医疗保健成本，同时提高患者护理质量。一个基本的政策问题是，广泛分布的基于证据的自我管理计划——慢性病自我管理计划（CDSMP），在管理慢性病的同时提高生活质量方面是否具有成本效益。本研究利用来自国家 CDSMP 研究的数据，主要目的是估计至少有一种慢性病的个体中 CDSMP 计划的成本效益。第二个目标是确定成本效益比如何因抑郁状况而异。EuroQol-5D（EQ-5D）用于衡量 CDSMP 参与者的健康相关生活质量（HRQOL），然后将其转换为成本效益分析的质量调整生命年（QALY）。完成 CDSMP 计划的参与者在基线至 12 个月随访期间经历了更高的 EQ-5D 评分（从 0.736 增加到 0.755；p < 0.001）。增量成本效益比（ICER）范围从每 QALY 83285 美元到 31285 美元不等，这与 50000 美元/QALY 的常见基准相当。基于基线抑郁状况的 ICER 表明，根据患者健康问卷-8 评分诊断为抑郁症的患者每获得一个 QALY 的成本更高。然而，在考虑这一点估计值时应该谨慎，因为 CDSMP 参与者的平均成本是一个粗略的估计，并且基于几个简化的假设。对于决策者来说，确定能够降低社区居住成年人慢性病负担的成本效益策略至关重要，以分配有限的资源。政策制定者和社区组织可以利用这些信息来指导资金决策，并为患有多种慢性健康状况的个人提供 CDSMP 计划。
