Zhao Yuejen, Guthridge Steven, Falhammar Henrik, Flavell Howard, Cadilhac Dominique A
Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia.
Menzies School of Health Research, Darwin, Northern Territory, Australia.
BMJ Open. 2017 Oct 5;7(10):e015033. doi: 10.1136/bmjopen-2016-015033.
To assess cost-effectiveness of stroke care for Aboriginal compared with non-Aboriginal patients in the Northern Territory (NT), Australia.
Cost-effectiveness analysis using data from a cohort-based follow-up study of stroke incidents.
Public hospitals in the NT from 1992 to 2013.
Individual patient data were extracted and linked from the hospital inpatient and primary care information systems.
Incremental cost-effectiveness ratios were calculated and assessed graphically. Survival time was used to measure effectiveness of stroke care, in comparison with the net costs per life-year gained, from a healthcare perspective, by applying multivariable models to account for time-dependent confounding.
2158 patients with incident stroke were included (1171 males, 1178 aged <65 years and 966 from remote areas). 992 patients were of Aboriginal origin (46.0%, disproportionately higher than the population proportion of 27%). Of all cases, 42.6% were ischaemic and 29.8% haemorrhagic stroke. Average age of stroke onset was 51 years in Aboriginal, compared with 65 years in non-Aboriginal patients (p<0.001). Aboriginal patients had 71.4% more hospital bed-days, and 7.4% fewer procedures than non-Aboriginal patients. Observed health costs averaged $A50 400 per Aboriginal compared with $A33 700 per non-Aboriginal patient (p<0.001). The differential costs and effects for each population were distributed evenly across the incremental cost-effectiveness plane threshold line, indicating no difference in cost-effectiveness between populations. After further adjustment for confounding and censoring, cost-effectiveness appeared greater for Aboriginal than non-Aboriginal patients, but this was not statistically significant (p=0.25).
Stroke care for the NT Aboriginal population is at least as cost-effective as the non-Aboriginal population. Stroke care presents worthwhile and equitable survival benefits for Aboriginal patients in remote communities, notwithstanding their higher level burden of disease. These findings are relevant for healthcare planning and policy development regarding equal access to stroke care for Aboriginal patients.
评估澳大利亚北领地（NT）原住民与非原住民中风患者的中风护理成本效益。
使用基于队列的中风事件随访研究数据进行成本效益分析。
1992年至2013年北领地的公立医院。
从医院住院患者和初级护理信息系统中提取并链接个体患者数据。
计算增量成本效益比并进行图形评估。从医疗保健角度，通过应用多变量模型来考虑时间依赖性混杂因素，用生存时间衡量中风护理效果，并与每获得一个生命年的净成本进行比较。
纳入2158例中风事件患者（1171例男性，1178例年龄<65岁，966例来自偏远地区）。992例患者为原住民（占46.0%，远高于27%的人口比例）。在所有病例中，42.6%为缺血性中风，29.8%为出血性中风。原住民中风发病的平均年龄为51岁，而非原住民患者为65岁（p<0.001）。原住民患者的住院天数比非原住民患者多71.4%，手术次数比非原住民患者少7.4%。观察到的健康成本平均每位原住民为50400澳元，而非原住民患者为33700澳元（p<0.001）。各人群的差异成本和效果均匀分布在增量成本效益平面阈值线上，表明人群之间的成本效益无差异。在进一步调整混杂因素和审查后，原住民患者的成本效益似乎高于非原住民患者，但这无统计学意义（p = 0.25）。
北领地原住民的中风护理至少与非原住民人群一样具有成本效益。尽管原住民患者疾病负担较高，但中风护理为偏远社区的原住民患者带来了有价值且公平的生存益处。这些发现对于原住民患者平等获得中风护理的医疗保健规划和政策制定具有参考意义。
