Bouwsma Esther V A, Bosmans Judith E, van Dongen Johanna M, Brölmann Hans A M, Anema Johannes R, Huirne Judith A F
Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
BMJ Open. 2018 Jan 21;8(1):e017782. doi: 10.1136/bmjopen-2017-017782.
To evaluate the cost-effectiveness and cost-utility of an internet-based perioperative care programme compared with usual care for gynaecological patients.
Economic evaluation from a societal perspective alongside a stepped-wedge cluster-randomised controlled trial with 12 months of follow-up.
Secondary care, nine hospitals in the Netherlands, 2011-2014.
433 employed women aged 18-65 years scheduled for a hysterectomy and/or laparoscopic adnexal surgery.
The intervention comprised an internet-based care programme aimed at improving convalescence and preventing delayed return to work (RTW) following gynaecological surgery and was sequentially rolled out. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or to the intervention (n=227).
The primary outcome was duration until full sustainable RTW. Secondary outcomes were quality-adjusted life years (QALYs), health-related quality of life and recovery.
At 12 months, there were no statistically significant differences in total societal costs (€-647; 95% CI €-2116 to €753) and duration until RTW (-4.1; 95% CI -10.8 to 2.6) between groups. The incremental cost-effectiveness ratio (ICER) for RTW was 56; each day earlier RTW in the intervention group was associated with cost savings of €56 compared with usual care. The probability of the intervention being cost-effective was 0.79 at a willingness-to-pay (WTP) of €0 per day earlier RTW, which increased to 0.97 at a WTP of €76 per day earlier RTW. The difference in QALYs gained over 12 months between the groups was clinically irrelevant resulting in a low probability of cost-effectiveness for QALYs.
Considering that on average the costs of a day of sickness absence are €230, the care programme is considered cost-effective in comparison with usual care for duration until sustainable RTW after gynaecological surgery for benign disease. Future research should indicate whether widespread implementation of this care programme has the potential to reduce societal costs associated with gynaecological surgery.
NTR2933; Results.
评估基于互联网的围手术期护理方案与妇科患者常规护理相比的成本效益和成本效用。
从社会角度进行经济评估，并开展一项为期12个月随访的阶梯式楔形整群随机对照试验。
二级护理，荷兰的9家医院，2011年至2014年。
433名年龄在18至65岁之间、计划进行子宫切除术和/或腹腔镜附件手术的在职女性。
干预措施包括一项基于互联网的护理方案，旨在改善妇科手术后的康复情况并防止延迟复工，该方案逐步推出。根据所在医院的实施阶段，患者被分配至常规护理组（n = 206）或干预组（n = 227）。
主要结局是完全可持续复工前的持续时间。次要结局是质量调整生命年（QALY）、健康相关生活质量和康复情况。
在12个月时，两组之间的社会总成本（€ - 647；95%CI € - 2116至€753）和复工前持续时间（-4.1；95%CI -１０.８至2.6）无统计学显著差异。复工的增量成本效益比（ICER）为56；与常规护理相比，干预组每天提前复工可节省成本€56。在每天提前复工的支付意愿（WTP）为€0时，干预措施具有成本效益的概率为0.79，当每天提前复工的WTP为€76时，该概率增至0.97。两组在12个月内获得的QALY差异在临床上不显著，导致QALY具有成本效益的概率较低。
考虑到平均每天病假成本为€230，与常规护理相比，该护理方案对于良性疾病妇科手术后直至可持续复工的持续时间而言具有成本效益。未来研究应表明广泛实施该护理方案是否有可能降低与妇科手术相关的社会成本。
NTR2933；结果。
