Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium.
Faculty of Medicine and Pharmacy, Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium.
Int J Geriatr Psychiatry. 2020 Jun;35(6):601-609. doi: 10.1002/gps.5276. Epub 2020 Feb 13.
To evaluate cost-effectiveness of an in-home respite care program in addition to standard community-based dementia care to support informal caregivers of persons with dementia compared with standard community-based dementia care.
An age-dependent decision-analytic Markov model was applied from a third-party payer and a societal perspective projecting results of a quasi-experimental study over a time horizon of 5 years assuming a repetition of the program every 6 months. Additionally, to deal with uncertainty and to test robustness of the model scenario, one-way and probabilistic sensitivity analyses were conducted.
Implementing the program resulted in a quality-adjusted life year (QALY) gain of 0.14 in favor of the invention group compared with controls and an incremental cost of 1270€ from the third-party payer perspective and of 1220€ from the societal perspective. Next, an incremental cost-effectiveness ratio of 9042€/QALY and of 8690€/QALY was found in the base case, from the third-party payer perspective and the societal perspective, respectively. The scenario, one-way sensitivity, and probabilistic analyses demonstrated robustness of the base-case results.
This cost-effectiveness analysis suggests that an in-home respite care program in addition to standard community-based dementia care is a cost-effective approach compared with standard community-based dementia care only. These findings provide more insight into the value of such services for the patient, the caregiver, and for society.
评估家庭暂托护理计划在标准社区痴呆护理基础上对痴呆患者的非专业照护者的成本效益，该计划旨在为痴呆患者提供支持，与标准社区痴呆护理相比。
采用基于年龄的决策分析马尔可夫模型，从第三方支付者和社会角度出发，根据一项准实验研究的结果进行预测，研究时间跨度为 5 年，假设每 6 个月重复一次该计划。此外，为了应对不确定性并测试模型方案的稳健性，进行了单因素敏感性分析和概率敏感性分析。
与对照组相比，实施该计划可使创新组的健康调整生命年（QALY）增加 0.14 个，从第三方支付者的角度来看，增量成本为 1270 欧元，从社会角度来看，增量成本为 1220 欧元。其次，在基础情况下，从第三方支付者和社会角度来看，增量成本效益比分别为 9042 欧元/QALY 和 8690 欧元/QALY。单因素敏感性分析和概率敏感性分析的结果表明，基础案例结果具有稳健性。
本成本效益分析表明，家庭暂托护理计划在标准社区痴呆护理基础上是一种具有成本效益的方法，优于单纯的标准社区痴呆护理。这些发现为这种服务对患者、照护者和社会的价值提供了更多的了解。
