Maru Shoko, Byrnes Joshua, Carrington Melinda J, Chan Yih-Kai, Thompson David R, Stewart Simon, Scuffham Paul A
Centre for Applied Health Economics, School of Medicine, Population & Social Health Research, Menzies Health Institute Queensland, Griffith University, Australia.
Centre for Applied Health Economics, School of Medicine, Population & Social Health Research, Menzies Health Institute Queensland, Griffith University, Australia.
Int J Cardiol. 2015 Dec 15;201:368-75. doi: 10.1016/j.ijcard.2015.08.066. Epub 2015 Aug 8.
To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics.
A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost-utility ratios were computed based on quality-adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB.
During median follow-up of 3.2 years, HBI was associated with slightly higher QALYs (+0.26 years per person; p=0.078) and lower total healthcare costs (AU$ -13,100 per person; p=0.025) mainly driven by significantly reduced duration of all-cause hospital stay (-10 days; p=0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions <1 year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia.
Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity.
评估两种多学科管理方案对因慢性心力衰竭（CHF）住院的老年患者的长期成本效益，以及患者特征如何影响该效益。
在一项针对280名从澳大利亚三家三级医院出院回家的老年CHF患者的随机对照试验的同时进行了基于试验的分析。比较了两种干预措施：基于家庭的干预（HBI），包括家访和社区护理，以及基于专科诊所的干预（CBI）。根据质量调整生命年（QALY）和总医疗费用计算自抽样的增量成本效用比。基于增量净货币效益（NMB）构建成本效益可接受性曲线。我们进行了多元线性回归，以探索哪些患者特征可能影响患者层面的NMB。
在3.2年的中位随访期内，HBI与略高的QALY（每人+0.26年；p=0.078）和较低的总医疗费用（每人-13,100澳元；p=0.025）相关，这主要是由于全因住院时间显著缩短（-10天；p=0.006）。在每增加一个QALY支付意愿阈值为50,000澳元的情况下，HBI具有更高价值的概率为96%，HBI的增量NMB为24,342澳元（贴现率为5%）。与NMB增加相关的变量包括HBI（与CBI相比）、较低的查尔森合并症指数、无低钠血症、HF病程较短、过去1年内较少的HF住院次数以及患者较高的自我护理信心。在合并症较少、自我护理信心较低或无低钠血症的患者中，HBI的净效益进一步增加。
与CBI相比，HBI在合并症严重的老年CHF患者中可能具有成本效益。
