Kaier Klaus, von Kampen Frederike, Baumbach Hardy, von Zur Mühlen Constantin, Hehn Philip, Vach Werner, Zehender Manfred, Bode Christoph, Reinöhl Jochen
Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.
Department of Cardiology, Heart Center Freiburg University, Freiburg im Breisgau, Germany.
BMC Health Serv Res. 2017 Jul 11;17(1):473. doi: 10.1186/s12913-017-2432-8.
This study presents data on post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement over a two year period.
Based on a prospective clinical trial, post-discharge utilization of health services and status of assistance were collected for 151 elderly patients via 2250 monthly telephone interviews, valued using standardized unit costs and analysed using two-part regression models.
At month 1 post-discharge, total costs of care are substantially elevated (monthly mean: €3506.7) and then remain relatively stable over the following 23 months (monthly mean: €622.3). As expected, the majority of these costs are related to in-hospital care (~98% in month 1 post-discharge and ~72% in months 2-24). Patients that died during follow-up were associated with substantially higher cost estimates of in-hospital care than those surviving the two-year study period, while patients' age and other patient characteristics were of minor relevance. Estimated costs of outpatient care are lower at month 1 than during the rest of the study period, and not affected by the event of death during follow-up. The estimated costs of nursing care are, in contrast, much higher in year 2 than in year 1 and differ substantially by gender and type of procedure as well as by patients' age. Overall, these monthly cost estimates add up to €10,352 for the first and €7467.6 for the second year post-discharge.
Substantial cost increases at month 1 post-discharge and in case of death during follow-up are the main findings of the study, which should be taken into account in future economic evaluations on the topic. Application of standardized unit costs in combination with monthly patient interviews allows for a far more precise estimate of the variability in post-discharge health service utilization in this group of patients than the ones given in previous studies.
German Clinical Trial Register Nr. DRKS00000797 .
本研究展示了在两年时间内接受经导管或外科主动脉瓣置换术治疗的患者出院后护理成本的数据。
基于一项前瞻性临床试验，通过2250次月度电话访谈收集了151名老年患者出院后医疗服务的使用情况和援助状况，使用标准化单位成本进行估值，并采用两部分回归模型进行分析。
出院后第1个月，护理总成本大幅升高（月均值：3506.7欧元），随后在接下来的23个月内保持相对稳定（月均值：622.3欧元）。正如预期的那样，这些成本的大部分与住院护理有关（出院后第1个月约为98%，第2 - 24个月约为72%）。随访期间死亡的患者与两年研究期内存活患者相比，住院护理成本估计要高得多，而患者的年龄和其他患者特征相关性较小。门诊护理的估计成本在第1个月低于研究期的其余时间，且不受随访期间死亡事件的影响。相比之下，护理成本估计在第2年比第1年高得多，并且因性别、手术类型以及患者年龄而有很大差异。总体而言，这些月度成本估计在出院后的第一年总计为10352欧元，第二年为7467.6欧元。
出院后第1个月成本大幅增加以及随访期间死亡情况下成本增加是本研究的主要发现，在未来关于该主题的经济评估中应予以考虑。与月度患者访谈相结合应用标准化单位成本，比以往研究更能精确估计该组患者出院后医疗服务利用的变异性。
德国临床试验注册编号DRKS00000797 。
