Pirhonen Laura, Bolin Kristian, Olofsson Elisabeth Hansson, Fors Andreas, Ekman Inger, Swedberg Karl, Gyllensten Hanna
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Göteborg, Sweden.
Centre for Person-Centred Care (GPCC), University of Gothenburg, Göteborg, Sweden.
Pharmacoecon Open. 2019 Dec;3(4):495-504. doi: 10.1007/s41669-019-0126-3.
Costs associated with an ACS incident are most pronounced in the acute phase but are also considerably long after the initial hospitalisation, partly due to considerable productivity losses, which constitute a substantial part of the economic burden of the disease. Studies suggest that person-centred care may improve health-related quality of life and reduce the costs associated with the disease.
The aim of this study was to calculate the cost-effectiveness of a person-centred care intervention compared with usual care in patients with acute coronary syndrome (ACS), in a Swedish setting.
Primary data from a randomised controlled trial of a person-centred intervention in patients with ACS was used. The person-centred intervention involved co-creation of a health plan between the patient and healthcare professionals, based on the patient's narrative. Thereafter, goals for the recovery period were set and followed-up continuously throughout the intervention. The clinical data, collected during the randomised controlled trial, was complemented with data from national health registers and the Swedish Social Insurance Agency. The study was conducted at two hospitals situated in a Swedish municipality. Patients were enrolled between June 2011 and February 2014 (192 patients were included in this study; 89 in the intervention group and 103 in the control group). Incremental cost-effectiveness ratios were calculated separately for the age groups < 65 years and ≥ 65 years in order to account for the age of retirement in Sweden. The cost-effectiveness ratios were calculated using health-related quality of life (EQ-5D) and costs associated with healthcare and pharmaceutical utilisation, and productivity losses.
Treatment effects and costs differed between those below and those above the age of 65 years. The base-case calculations showed that person-centred care was more effective and less costly compared with usual care for patients under 65 years of age, while usual care was more effective and less costly in the older age group. Probabilistic sensitivity analyses resulted in a 90% likelihood that person-centred care is cost-effective compared with usual care for patients with ACS under the age of 65 years.
Person-centred care was found to be cost-effective compared with usual care for patients with acute coronary syndrome under the age of 65 years. This clinical trial is registered at Researchweb (ID 65791).
与急性冠状动脉综合征（ACS）事件相关的费用在急性期最为显著，但在初次住院后的很长一段时间内也相当可观，部分原因是生产力损失巨大，这构成了该疾病经济负担的很大一部分。研究表明，以患者为中心的护理可能会改善与健康相关的生活质量，并降低与该疾病相关的费用。
本研究的目的是在瑞典的背景下，计算与常规护理相比，以患者为中心的护理干预对急性冠状动脉综合征（ACS）患者的成本效益。
使用了一项针对ACS患者的以患者为中心干预的随机对照试验的原始数据。以患者为中心的干预包括根据患者的叙述，在患者和医护人员之间共同制定健康计划。此后，设定恢复期目标，并在整个干预过程中持续进行随访。随机对照试验期间收集的临床数据，辅以国家健康登记册和瑞典社会保险局的数据。该研究在瑞典一个市镇的两家医院进行。患者于2011年6月至2014年2月入组（本研究纳入192例患者；干预组89例，对照组103例）。为了考虑瑞典的退休年龄，分别计算了年龄小于65岁和≥65岁年龄组的增量成本效益比。成本效益比使用与健康相关的生活质量（EQ-5D）以及与医疗保健和药品使用相关的成本和生产力损失来计算。
65岁以下和65岁以上人群的治疗效果和成本有所不同。基础病例计算表明，与常规护理相比，以患者为中心的护理对65岁以下患者更有效且成本更低，而在老年组中常规护理更有效且成本更低。概率敏感性分析结果显示，对于65岁以下的ACS患者，与常规护理相比，以患者为中心的护理有90%的可能性具有成本效益。
对于65岁以下的急性冠状动脉综合征患者，与常规护理相比，以患者为中心的护理被发现具有成本效益。该临床试验已在Researchweb（ID 65791）注册。
