From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.P., L.Z., Z.L., X.M., Y.W., H.L., L.L., Y.W.).
China National Clinical Research Centre for Neurological Diseases, Beijing (Y.P., L.Z., Z.L., X.M., Y.W., H.L., L.L., Y.W.).
Stroke. 2020 Apr;51(4):1265-1271. doi: 10.1161/STROKEAHA.119.027980. Epub 2020 Feb 5.
Background and Purpose- Multifaceted quality improvement interventions of stroke care have been shown to improve hospital personnel adherence to evidence-based performance measures and subsequent stroke outcomes. This study aimed to evaluate the cost-effectiveness of a multifaceted quality improvement intervention for stroke care in China, the world's largest low- and middle-income country. Methods- A short-term decision tree model and a long-term Markov model were used to analyze the cost-effectiveness of a multifaceted quality improvement intervention for patients with acute ischemic stroke. Outcomes, transition probability, and cost data were obtained from a recent clinical trial and the published literature. The benefit of the intervention was assessed by the costs per quality-adjusted life-years gained in the short- and long-term. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the findings. Results- Compared with usual care, a multifaceted quality improvement intervention for stroke care was found to be cost-effective in the first year and highly cost-effective from the second year onward. In the long-term, the intervention yielded a lifetime gain of 0.246 quality-adjusted life-years at an additional cost of Chinese Yuan Renminbi 1510 (US $230), resulting in a cost of Chinese Yuan Renminbi 6138 (US $940) per quality-adjusted life-year gained. Probabilistic sensitivity analysis indicated that the intervention was highly cost-effective in 99.9% of the simulation runs at a willingness-to-pay threshold of Chinese Yuan Renminbi 59 700 (1× gross domestic product per capita of China in 2017, US $9200) per quality-adjusted life-year. Conclusions- A multifaceted quality improvement intervention for stroke care was highly cost-effective in China. The results of this study may be used as a reference for delivering such interventions in low- and middle-income countries and in underserved areas of high-income countries.
背景与目的- 多项针对卒中护理的质量改进干预措施已被证明可提高医院人员对基于证据的绩效指标的依从性，并改善后续的卒中结局。本研究旨在评估在中国（全球最大的中低收入国家）实施一项针对卒中护理的多方面质量改进干预措施的成本效益。
方法- 采用短期决策树模型和长期 Markov 模型分析了一项针对急性缺血性卒中患者的多方面质量改进干预措施的成本效益。结果、转移概率和成本数据来自最近的一项临床试验和已发表的文献。通过短期和长期获得的每增加一个质量调整生命年的成本来评估干预措施的效益。进行了单因素和概率敏感性分析以评估研究结果的不确定性。
结果- 与常规护理相比，卒中护理的多方面质量改进干预措施在第一年具有成本效益，从第二年开始具有高度成本效益。从长期来看，该干预措施可使患者获得 0.246 个质量调整生命年的终生获益，额外增加的成本为人民币 1510 元（230 美元），从而使每个质量调整生命年的成本为人民币 6138 元（940 美元）。概率敏感性分析表明，在支付意愿阈值为人民币 59700 元（2017 年中国人均国内生产总值的 1 倍，9200 美元）时，该干预措施在模拟运行的 99.9%中具有高度成本效益。
结论- 在中国，针对卒中护理的多方面质量改进干预措施具有高度成本效益。本研究结果可作为在中低收入国家以及高收入国家服务不足地区实施此类干预措施的参考。
