Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Cancer Med. 2020 Apr;9(8):2723-2731. doi: 10.1002/cam4.2837. Epub 2020 Feb 23.
The purpose of this analysis was to determine the cost-effectiveness of a Collaborative Care Model (CCM)-based, centralized telecare approach to delivering rehabilitation services to late-stage cancer patients experiencing functional limitations.
Data for this analysis came from the Collaborative Care to Preserve Performance in Cancer (COPE) trial, a randomized control trial of 516 patients assigned to: (a) a control group (arm A), (b) tele-rehabilitation (arm B), and (c) tele-rehabilitation plus pharmacological pain management (arm C). Patient quality of life was measured using the EQ-5D-3L at baseline, 3-month, and 6-month follow-up. Direct intervention costs were measured from the experience of the trial. Participants' hospitalization data were obtained from their medical records, and costs associated with these encounters were estimated from unit cost data and hospital-associated utilization information found in the literature. A secondary analysis of total utilization costs was conducted for the subset of COPE trial patients for whom comprehensive cost capture was possible.
In the intervention-only model, tele-rehabilitation (arm B) was found to be the dominant strategy, with an incremental cost-effectiveness ratio (ICER) of $15 494/QALY. At the $100 000 willingness-to-pay threshold, this tele-rehabilitation was the cost-effective strategy in 95.4% of simulations. It was found to be cost saving compared to enhanced usual care once the downstream hospitalization costs were taken into account. In the total cost analysis, total inpatient hospitalization costs were significantly lower in both tele-rehabilitation (arm B) and tele-rehabilitation plus pain management (arm C) compared to control (arm A), (P = .048).
The delivery of a CCM-based, centralized tele-rehabilitation intervention to patients with advanced stage cancer is highly cost-effective. Clinicians and care teams working with this vulnerable population should consider incorporating such interventions into their patient care plans.
本分析旨在确定基于协作式护理模式（CCM）的集中远程护理方法在为晚期癌症患者提供康复服务方面的成本效益，这些患者存在功能受限问题。
本分析的数据来自协作式护理以保留癌症患者功能（COPE）试验，这是一项对 516 名患者进行的随机对照试验，患者被随机分配到以下三组：（a）对照组（A 组）、（b）远程康复组（B 组）和（c）远程康复加药物治疗疼痛组（C 组）。患者的生活质量使用 EQ-5D-3L 在基线、3 个月和 6 个月随访时进行测量。直接干预成本是根据试验经验来衡量的。参与者的住院数据是从他们的病历中获得的，与这些就诊相关的费用是根据文献中的单位成本数据和医院使用信息来估计的。对 COPE 试验中能够全面捕捉成本的患者亚组进行了总利用成本的二次分析。
在仅干预模型中，远程康复（B 组）被发现是一种具有成本效益的策略，增量成本效益比（ICER）为 15494 美元/QALY。在 10 万美元的意愿支付阈值下，在 95.4%的模拟中，这种远程康复是具有成本效益的策略。一旦考虑到下游住院费用，与增强的常规护理相比，它具有成本节约效果。在总成本分析中，与对照组（A 组）相比，远程康复（B 组）和远程康复加疼痛管理（C 组）的总住院治疗费用显著降低（P=0.048）。
向晚期癌症患者提供基于 CCM 的集中远程康复干预措施具有很高的成本效益。与这一脆弱人群合作的临床医生和护理团队应考虑将此类干预措施纳入其患者护理计划。
