College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
PLoS One. 2019 Sep 11;14(9):e0222049. doi: 10.1371/journal.pone.0222049. eCollection 2019.
Frailty is a major health issue which impacts the life of older people, posing a significant challenge to the health system. One of the key emerging areas is the development of frailty interventions to halt or reverse the progression of the condition. In many countries, economic evidence is required to inform public funding decisions for such interventions, and cost-effectiveness models are needed to estimate long-term costs and effects. Such models should capture current clinical understanding of frailty, its progression and its health consequences. The objective of this paper is to present a conceptual model of frailty that can be used to inform the development of a cost-effectiveness model to evaluate frailty interventions.
After critical analysis of the clinical and economic literature, a Delphi study consisting of experts from the disciplines of clinical medicine and epidemiology was undertaken to inform the key components of the conceptual model. We also identified relevant databases that can be used to populate and validate the model.
A list of significant health states/events for which frailty is a strong independent risk factor was identified (e.g., hip fracture, hospital admission, delirium, death). We also identified a list of important patient attributes that may influence disease progression (e.g., age, gender, previous hospital admissions, depression). A number of large-scale relevant databases were also identified to populate and validate the cost-effectiveness model. Face validity of model structure was confirmed by experts.
The proposed conceptual model is being used as a basis for developing a new cost-effectiveness model to estimate lifetime costs and outcomes associated with a range of frailty interventions. Using an appropriate model structure, which more accurately reflects the natural history of frailty, will improve model transparency and accuracy. This will ultimately lead to better informed public funding decisions around interventions to manage frailty.
衰弱是一个主要的健康问题，影响老年人的生活，对医疗系统构成重大挑战。其中一个关键的新兴领域是开发衰弱干预措施，以阻止或逆转病情的进展。在许多国家，需要经济证据来为这些干预措施提供公共资金决策依据，并且需要成本效益模型来估计长期成本和效果。这些模型应捕捉当前对衰弱的临床理解、其进展及其健康后果。本文的目的是提出一个衰弱的概念模型，可用于为评估衰弱干预措施的成本效益模型的开发提供信息。
在对临床和经济文献进行批判性分析后，我们进行了一项由临床医学和流行病学领域的专家参与的 Delphi 研究，以告知概念模型的关键组成部分。我们还确定了可用于填充和验证模型的相关数据库。
确定了衰弱是一个强有力的独立风险因素的重要健康状态/事件列表（例如髋部骨折、住院、谵妄、死亡）。我们还确定了一系列可能影响疾病进展的重要患者属性列表（例如年龄、性别、以前的住院、抑郁）。还确定了一些大型相关数据库来填充和验证成本效益模型。专家确认了模型结构的表面有效性。
所提出的概念模型正被用作开发新的成本效益模型的基础，以估计与一系列衰弱干预措施相关的终生成本和结果。使用更准确地反映衰弱自然史的适当模型结构将提高模型的透明度和准确性。这最终将导致在管理衰弱的干预措施方面做出更明智的公共资金决策。
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