Department of Health Management and Policy, University of Iowa, 145 North Riverside Drive, CPHB N211, Iowa City, IA, 52242, USA.
Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
Osteoporos Int. 2017 Oct;28(10):3061-3066. doi: 10.1007/s00198-017-4113-1. Epub 2017 Jun 15.
In a large, pragmatic clinical trial, we calculated the costs of achieving four successful patient-centered outcomes using a tailored patient activation DXA result letter accompanied by a bone health brochure. The cost to achieve one successful outcome (e.g., a 0.5 standard deviation improvement in care satisfaction) ranged from $127.41 to $222.75.
Pragmatic randomized controlled trials (RCTs) should focus on patient-centered outcomes and report the costs for achieving those outcomes. We calculated per person incremental intervention costs, the number-needed-to-treat (NNT), and incremental per patient costs (cost per NNT) for four patient-centered outcomes in a direct-to-patient bone healthcare intervention.
The Patient Activation after DXA Result Notification (PAADRN) pragmatic RCT enrolled 7749 patients presenting for DXA at three health centers between February 2012 and August 2014. Interviews occurred at baseline and 52 weeks post-DXA. Intervention subjects received an individually tailored DXA result letter accompanied by an educational bone health brochure 4 weeks post-DXA, while the usual care subjects did not. Outcomes focused on patients (a) correctly identifying their results, (b) contacting their providers, (c) discussing their results with their providers, and (d) satisfaction with their bone healthcare. NNTs were determined using intention-to-treat linear probability models, per person incremental intervention costs were calculated, and costs per NNT were computed.
Mean age was 66.6 years old, 83.8% were women, and 75.3% were non-Hispanic whites. The incremental per patient cost (costs per NNT) to increase the ability of a patient to (a) correctly identify their DXA result was $171.07; (b) contact their provider about their DXA result was $222.75; (c) discuss their DXA result with their provider was $193.55; and (d) achieve a 0.5 SD improvement in satisfaction with their bone healthcare was $127.41.
An individually tailored DXA result letter accompanied by an educational brochure can improve four patient-centered outcomes at a modest cost.
clinicaltrials.gov identifier NCT01507662.
在一项大型、实用的临床试验中，我们计算了使用定制的患者激活 DXA 结果信函和骨健康小册子来实现四个以患者为中心的结果的成本。实现一个成功结果（例如，护理满意度提高 0.5 个标准差）的成本范围为 127.41 美元至 222.75 美元。
实用随机对照试验（RCT）应侧重于以患者为中心的结果，并报告实现这些结果的成本。我们在一项直接面向患者的骨保健干预措施中计算了四个以患者为中心的结果的每人增量干预成本、需要治疗的人数（NNT）和每个患者的增量成本（NNT 成本）。
患者在 DXA 结果通知后激活（PAADRN）实用 RCT 招募了 2012 年 2 月至 2014 年 8 月期间在三个健康中心进行 DXA 的 7749 名患者。基线和 DXA 后 52 周进行访谈。干预组在 DXA 后 4 周收到个性化定制的 DXA 结果信函和教育性骨健康小册子，而常规护理组则没有。结果侧重于患者（a）正确识别其结果，（b）与提供者联系，（c）与提供者讨论其结果，以及（d）对其骨保健的满意度。使用意向治疗线性概率模型确定 NNT，计算每人增量干预成本，并计算 NNT 成本。
平均年龄为 66.6 岁，83.8%为女性，75.3%为非西班牙裔白人。增加患者（a）正确识别其 DXA 结果的能力的每位患者增量成本（NNT 成本）为 171.07 美元；（b）就其 DXA 结果与提供者联系的成本为 222.75 美元；（c）与提供者讨论其 DXA 结果的成本为 193.55 美元；以及（d）实现对其骨保健满意度提高 0.5 个标准差的成本为 127.41 美元。
个性化定制的 DXA 结果信函和教育小册子可以以适度的成本改善四个以患者为中心的结果。
clinicaltrials.gov 标识符 NCT01507662。
