远程医疗中的成本效益分析：家庭远程监测、护士电话支持与慢性心力衰竭管理中常规护理的比较。

Cost-Effectiveness Analysis in Telehealth: A Comparison between Home Telemonitoring, Nurse Telephone Support, and Usual Care in Chronic Heart Failure Management.

机构信息

Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Professional Health Solutions and Services Department, Philips Research Europe, Eindhoven, The Netherlands.

Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.

出版信息

Value Health. 2018 Jul;21(7):772-782. doi: 10.1016/j.jval.2017.11.011. Epub 2018 Mar 21.

DOI:10.1016/j.jval.2017.11.011

PMID:30005749

Abstract

OBJECTIVES

To assess the cost effectiveness of home telemonitoring (HTM) and nurse telephone support (NTS) compared with usual care (UC) in the management of patients with chronic heart failure, from a third-party payer's perspective.

METHODS

We developed a Markov model with a 20-year time horizon to analyze the cost effectiveness using the original study (Trans-European Network-Home-Care Management System) and various data sources. A probabilistic sensitivity analysis was performed to assess the decision uncertainty in our model.

RESULTS

In the original scenario (which concerned the cost inputs at the time of the original study), HTM and NTS interventions yielded a difference in quality-adjusted life-years (QALYs) gained compared with UC: 2.93 and 3.07, respectively, versus 1.91. An incremental net monetary benefit analysis showed €7,697 and €13,589 in HTM and NTS versus UC at a willingness-to-pay (WTP) threshold of €20,000, and €69,100 and €83,100 at a WTP threshold of €80,000, respectively. The incremental cost-effectiveness ratios were €12,479 for HTM versus UC and €8,270 for NTS versus UC. The current scenario (including telenurse cost inputs in NTS) yielded results that were slightly different from those for the original scenario, when comparing all New York Heart Association (NYHA) classes of severity. NTS dominated HTM, compared with UC, in all NYHA classes except NYHA IV.

CONCLUSIONS

This modeling study demonstrated that HTM and NTS are viable solutions to support patients with chronic heart failure. NTS is cost-effective in comparison with UC at a WTP of €9000/QALY or higher. Like NTS, HTM improves the survival of patients in all NYHA classes and is cost-effective in comparison with UC at a WTP of €14,000/QALY or higher.

摘要

目的

从第三方支付者的角度评估家庭远程监测（HTM）和护士电话支持（NTS）与常规护理（UC）相比在慢性心力衰竭患者管理中的成本效益。

方法

我们开发了一个具有 20 年时间范围的 Markov 模型，使用原始研究（跨欧洲网络-家庭护理管理系统）和各种数据源来分析成本效益。进行了概率敏感性分析以评估我们模型中的决策不确定性。

结果

在原始方案（涉及原始研究时的成本投入）中，HTM 和 NTS 干预与 UC 相比，在获得的质量调整生命年（QALY）方面有所不同：分别为 2.93 和 3.07，而 1.91。增量净货币收益分析表明，在 WTP 阈值为 20,000 欧元时，HTM 和 NTS 相对于 UC 分别为 7,697 欧元和 13,589 欧元，在 WTP 阈值为 80,000 欧元时，分别为 69,100 欧元和 83,100 欧元。与 UC 相比，HTM 的增量成本效益比为 12,479 欧元，NTS 的增量成本效益比为 8,270 欧元。当前方案（包括 NTS 中的远程护士成本投入）与原始方案相比，在比较所有纽约心脏协会（NYHA）严重程度等级时，结果略有不同。在除 NYHA IV 之外的所有 NYHA 等级中，NTS 相对于 UC 均优于 HTM。

结论

这项建模研究表明，HTM 和 NTS 是支持慢性心力衰竭患者的可行解决方案。与 UC 相比，NTS 在 WTP 为 9,000 欧元/QALY 或更高时具有成本效益。与 NTS 一样，HTM 提高了所有 NYHA 等级患者的生存率，并且在 WTP 为 14,000 欧元/QALY 或更高时与 UC 相比具有成本效益。