The George Institute for Global Health, UNSW Sydney, Sydney, NSW.
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW.
Med J Aust. 2020 Jul;213(2):73-78. doi: 10.5694/mja2.50667. Epub 2020 Jun 27.
To assess the cost-effectiveness of a computer-guided quality improvement intervention for primary health care management of cardiovascular disease (CVD) in people at high risk.
Modelled cost-effectiveness analysis of the HealthTracker intervention and usual care for people with high CVD risk, based on TORPEDO trial data on prescribing patterns, changes in intermediate risk factors (low-density lipoprotein cholesterol, systolic blood pressure), and Framingham risk scores.
Hypothetical population of people with high CVD risk attending primary health care services in a New South Wales primary health network (PHN) of mean size.
HealthTracker, integrated into health care provider electronic health record systems, provides real time decision support, risk communication, a clinical audit tool, and a web portal for performance feedback.
Incremental cost-effectiveness ratios (ICERs): difference in costs of the intervention and usual care divided by number of CVD events averted with HealthTracker.
The estimated numbers of major CVD events over five years per 1000 patients at high CVD risk were lower in PHNs using HealthTracker, both for patients with prior CVD events (secondary prevention; 259 v 267 with usual care) and for those without prior events (primary prevention; 168 v 176). Medication costs were higher and hospitalisation costs lower with HealthTracker than with usual care for both primary and secondary prevention. The estimated ICER for one averted CVD event was $7406 for primary prevention and $17 988 for secondary prevention.
Modelled cost-effectiveness analyses provide information that can assist decisions about investing in health care quality improvement interventions. We estimate that HealthTracker could prevent major CVD events for less than $20 000 per event averted.
TRIAL REGISTRATION (TORPEDO): Australian New Zealand Clinical Trials Registry, ACTRN 12611000478910.
评估针对高心血管疾病（CVD）风险人群的初级保健管理的计算机引导质量改进干预措施的成本效益。
基于 TORPEDO 试验关于处方模式、中间风险因素（低密度脂蛋白胆固醇、收缩压）变化和弗雷明汉风险评分的数据，对 HealthTracker 干预措施和常规护理进行建模成本效益分析，以评估高 CVD 风险人群的获益。
新南威尔士州初级卫生网络（PHN）中接受初级保健服务的高 CVD 风险人群的假设人群，PHN 平均规模。
HealthTracker 整合到医疗保健提供者的电子健康记录系统中，提供实时决策支持、风险沟通、临床审计工具以及用于绩效反馈的网络门户。
增量成本效益比（ICER）：干预措施和常规护理的成本差异除以 HealthTracker 预防的 CVD 事件数。
在使用 HealthTracker 的 PHN 中，每 1000 名高 CVD 风险患者在五年内发生主要 CVD 事件的估计数量较低，对于有既往 CVD 事件的患者（二级预防；使用常规护理的 259 例与使用 HealthTracker 的 267 例）和无既往事件的患者（一级预防；使用常规护理的 168 例与使用 HealthTracker 的 176 例）均如此。对于一级和二级预防，与常规护理相比，HealthTracker 的药物治疗成本更高，而住院治疗成本更低。一级预防中每预防一次 CVD 事件的估计 ICER 为 7406 美元，二级预防为 17988 美元。
建模成本效益分析提供了有关投资医疗保健质量改进干预措施的决策信息。我们估计，HealthTracker 可以以低于每次预防事件 20000 美元的成本预防主要 CVD 事件。
试验注册（TORPEDO）：澳大利亚和新西兰临床试验注册处，ACTRN 12611000478910。
