Sørensen Sabrina Storgaard, Jensen Morten Berg, Pedersen Kjeld Møller, Ehlers Lars
Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark.
Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark; Department of Economics and Business Economics, Aarhus University, Aarhus V, Denmark.
Value Health. 2018 Feb;21(2):239-247. doi: 10.1016/j.jval.2017.08.001. Epub 2017 Sep 12.
To examine the heterogeneity in cost-effectiveness analyses of patient-tailored complex interventions.
Latent class analysis (LCA) was performed on data from a randomized controlled trial evaluating a patient-tailored case management strategy for patients suffering from chronic obstructive pulmonary disease (COPD). LCA was conducted on detailed process variables representing service variation in the intervention group. Features of the identified latent classes were compared for consistency with baseline demographic, clinical, and economic characteristics for each class. Classes for the control group, corresponding to the identified latent classes for the intervention group, were identified using multinomial logistic regression. Cost-utility analyses were then conducted at the class level, and uncertainty surrounding the point estimates was assessed by probabilistic sensitivity analysis.
The LCA identified three distinct classes: the psychologically care class, the extensive COPD care class, and the limited COPD care class. Patient baseline characteristics were in line with the features identified in the LCA. Evaluation of cost-effectiveness revealed highly disparate results, and case management for only the extensive COPD care class appeared cost-effective with an incremental cost-effectiveness ratio of £26,986 per quality-adjusted life-year gained using the threshold value set by the National Institute of Health and Care Excellence.
Findings indicate that researchers evaluating patient-tailored complex interventions need to address both supply-side variation and demand-side heterogeneity to link findings with outcome. The article specifically proposes the use of LCA because it is believed to have the potential to enable more appropriate targeting of complex care strategies.
研究针对患者定制的复杂干预措施成本效益分析中的异质性。
对一项随机对照试验的数据进行潜在类别分析（LCA），该试验评估了针对慢性阻塞性肺疾病（COPD）患者的患者定制病例管理策略。LCA针对代表干预组服务差异的详细过程变量进行。比较所识别潜在类别的特征，以使其与每个类别的基线人口统计学、临床和经济特征保持一致。使用多项逻辑回归确定对照组中与干预组所识别潜在类别相对应的类别。然后在类别层面进行成本效用分析，并通过概率敏感性分析评估点估计周围的不确定性。
LCA识别出三个不同的类别：心理护理类别、广泛COPD护理类别和有限COPD护理类别。患者基线特征与LCA中识别出的特征一致。成本效益评估显示结果差异很大，仅广泛COPD护理类别的病例管理似乎具有成本效益，使用英国国家卫生与临床优化研究所设定的阈值，每获得一个质量调整生命年的增量成本效益比为26,986英镑。
研究结果表明，评估针对患者定制的复杂干预措施的研究人员需要解决供应方差异和需求方异质性问题，以便将研究结果与结果联系起来。本文特别建议使用LCA，因为据信它有可能使复杂护理策略的目标定位更加恰当。
