Ruiz Juan Gabriel, Charpak Nathalie, Castillo Mario, Bernal Astrid, Ríos John, Trujillo Tammy, Córdoba María Adelaida
Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Cra 7 #40-62, Hospital Universitario San Ignacio, Piso 2, Bogotá, DC, Colombia; Fundación Canguro, Calle 44b #53-50, Bogotá, DC, Colombia; Servicio de Pediatría, Hospital Universitario San Ignacio, Cra 7 #40-62, Piso 7, Bogotá, DC, Colombia; Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, 11200 SW 8th St. AHC1-344, Miami, FL, 33199, USA.
Fundación Canguro, Calle 44b #53-50, Bogotá, DC, Colombia.
J Clin Epidemiol. 2017 Jun;86:91-100. doi: 10.1016/j.jclinepi.2016.10.007. Epub 2016 Oct 28.
Although kangaroo mother care (KMC) has been shown to be safe and effective in randomized controlled trials (RCTs), there are no published complete economic evaluations including the three components of the full intervention.
A cost utility analysis performed on the results of an RCT conducted in Bogotá, Colombia between 1993 and 1996. Hospital and ambulatory costs were estimated by microcosting in a sample of preterm infants from a University Hospital in Bogotá in 2011 and at a KMC clinic in the same period. Utility scores were assigned by experts by means of (1) direct ordering and scoring discrete health states and (2) constructing a multi-attribute utility function. Ninety-five percent confidence intervals (CIs) for the incremental cost-utility ratios (ICURs) were computed by the Fiellers theorem method. One-way sensitivity analysis on price estimates for valuing costs was performed.
ICUR at 1 year of corrected age was $ -1,546 per extra quality-adjusted life year gained using the KMC method (95% CI $ -7,963 to $ 4,910).
In Bogotá, the use of KMC is dominant: more effective and cost-saving. Although results from an economic analysis should not be extrapolated to different systems and communities, this dominant result suggests that KMC could be cost-effective in similar low and middle income countries settings.
尽管随机对照试验（RCT）已表明袋鼠式护理（KMC）是安全有效的，但尚无已发表的完整经济评估，其中涵盖完整干预措施的三个组成部分。
对1993年至1996年在哥伦比亚波哥大进行的一项随机对照试验结果进行成本效用分析。通过微观成本核算估计了2011年波哥大一家大学医院以及同期一家KMC诊所的早产儿样本的住院和门诊费用。效用得分由专家通过以下方式确定：（1）直接排序和对离散健康状态评分；（2）构建多属性效用函数。采用Fiellers定理方法计算增量成本效用比（ICUR）的95%置信区间（CI）。对成本估值的价格估计进行了单因素敏感性分析。
校正年龄1岁时，采用KMC方法每多获得一个质量调整生命年的ICUR为 -1546美元（95%CI为 -7963美元至4910美元）。
在波哥大，使用KMC具有优势：更有效且节省成本。尽管经济分析结果不应外推至不同的系统和社区，但这一优势结果表明，KMC在类似的低收入和中等收入国家环境中可能具有成本效益。
