Zwijsen S A, Bosmans J E, Gerritsen D L, Pot A M, Hertogh C M P M, Smalbrugge M
Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, the Netherlands.
Department of Health Sciences, EMGO+ Institute for Health and Care Research, Faculty of Earth Life Sciences, VU University, Amsterdam, the Netherlands.
Int J Geriatr Psychiatry. 2016 Jun;31(6):567-74. doi: 10.1002/gps.4360. Epub 2015 Sep 30.
The objective of the study was to evaluate the cost-effectiveness of implementing the Grip on Challenging Behaviour care programme (GRIP) on dementia special care units in comparison with usual care.
A stepped wedge design was used. Challenging behaviour and quality of life were measured using the Cohen Mansfield Agitation Inventory (CMAI) and the QUALIDEM. Quality-adjusted life years (QALYs) were calculated using the EuroQol-5D. Psychoactive medication use (range 0-5 per measurement) and sick leave were registered. Costs included medication, time spent on challenging behaviour and education. Costs and effects were analysed using linear multilevel regression. Incremental cost-effectiveness ratios were calculated. Statistical uncertainty was estimated using bootstrapping.
Seventeen dementia special care units participated. GRIP led to improvement on the QUALIDEM subscale social relations (1.6; 95% CI 0.18 to 3.4) and on the use of psychoactive medication (-0.73; 95% CI -1.1 to -0.46) and to a decrease in QALYs (-0.02; 95% CI -0.06 to -0.003). No significant effects on CMAI, sick leave and other QUALIDEM subscales were found. The intervention was not cost-effective in comparison with usual care with regard to CMAI score, QALYs and sick leave. The willingness to pay should be 320€/point improvement on the QUALIDEM subscale social relations and 370€/psychoactive medication less to reach a 0.95 probability of cost-effectiveness.
It depends on how much society is willing to pay whether GRIP can be considered cost-effective. Because the appropriateness of the current methods for analysing cost-effectiveness in this specific population is uncertain, the positive effects on behaviour, medication and job satisfactions should also be taken in account in the decision making.
本研究的目的是评估在痴呆症特殊护理病房实施具有挑战性的行为护理方案（GRIP）与常规护理相比的成本效益。
采用阶梯楔形设计。使用科恩·曼斯菲尔德激越量表（CMAI）和QUALIDEM来测量具有挑战性的行为和生活质量。使用欧洲五维度健康量表（EuroQol-5D）计算质量调整生命年（QALYs）。记录精神活性药物的使用情况（每次测量范围为0至5）和病假情况。成本包括药物、处理具有挑战性的行为所花费的时间和教育成本。使用线性多水平回归分析成本和效果。计算增量成本效益比。使用自抽样法估计统计不确定性。
17个痴呆症特殊护理病房参与了研究。GRIP使QUALIDEM量表的社会关系子量表得到改善（1.6；95%可信区间为0.18至3.4），精神活性药物的使用减少（-0.73；95%可信区间为-1.1至-0.46），QALYs降低（-0.02；95%可信区间为-0.06至-0.003）。未发现对CMAI、病假情况和其他QUALIDEM子量表有显著影响。就CMAI评分、QALYs和病假情况而言，与常规护理相比，该干预措施不具有成本效益。要达到0.95的成本效益概率，QUALIDEM量表社会关系子量表每提高1分的支付意愿应为320€，精神活性药物使用减少的支付意愿应为每减少1单位370€。
GRIP是否具有成本效益取决于社会愿意支付多少。由于目前在这一特定人群中分析成本效益的方法是否恰当尚不确定，在决策时也应考虑其对行为、药物使用和工作满意度的积极影响。
