患者发起的类风湿关节炎或银屑病关节炎患者 DMARD 自我监测服务：成本效益分析。

A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis.

机构信息

School of Health Sciences, City, University of London.

School of Health and Social Care, London South Bank University.

出版信息

Rheumatology (Oxford). 2021 Jan 5;60(1):277-287. doi: 10.1093/rheumatology/keaa309.

DOI:10.1093/rheumatology/keaa309

PMID:32734288

Abstract

OBJECTIVE

To determine whether a patient-initiated DMARD self-monitoring service for people on MTX is a cost-effective model of care for patients with RA or PsA.

METHODS

An economic evaluation was undertaken alongside a randomized controlled trial involving 100 patients. Outcome measures were quality of life and ESR assessed at baseline and post-intervention. Costs were calculated for healthcare usage using a United Kingdom National Health Service economic perspective. Sensitivity analysis was performed to explore the impact of nurse-led telephone helplines. Uncertainty around the cost-effectiveness ratios was estimated by bootstrapping and analysing the cost-effectiveness planes.

RESULTS

Fifty-two patients received the intervention and 48 usual care. The difference in mean cost per case indicated that the intervention was £263 more expensive (P < 0.001; 95% CI: £149.14, £375.86) when the helpline costs were accounted for and £94 cheaper (P = 0.08; 95% CI: -£199.26, £10.41) when these costs were absorbed by the usual service. There were, however, statistically significant savings for the patient (P = 0.02; 95% CI: -£28.98, £3.00). When costs and effectiveness measures of ESR and quality of life measured, using the Short Form-12v1, were combined this did not show the patient-initiated service to be cost-effective at a statistically significant level.

CONCLUSION

This patient-initiated service led to reductions in primary and secondary healthcare services that translated into reduced costs, in comparison with usual care, but were not cost-effective. Further work is needed to establish how nurse-led telephone triage services are integrated into rheumatology services and the associated costs of setting up and delivering them.

TRIAL REGISTRATION

ClinicalTrials.gov, http://clinicaltrials.gov, ISRCTN21613721.

摘要

目的

确定患者发起的 MTX 患者 DMARD 自我监测服务是否是 RA 或 PsA 患者的一种具有成本效益的护理模式。

方法

在一项涉及 100 名患者的随机对照试验中，同时进行了经济评估。在基线和干预后评估生活质量和 ESR 作为结果指标。使用英国国家卫生服务的经济视角计算了医疗保健使用的成本。通过引导和分析成本效果平面来进行敏感性分析，以探讨护士主导的电话热线的影响。通过自举法和分析成本效果平面来估计成本效果比的不确定性。

结果

52 名患者接受了干预，48 名患者接受了常规护理。每例病例的平均成本差异表明，当考虑到电话热线的成本时，干预措施的费用高出 263 英镑（P<0.001；95%置信区间：149.14 英镑，375.86 英镑），而当这些成本由常规服务吸收时，费用则低 94 英镑（P=0.08；95%置信区间：-199.26 英镑，10.41 英镑）。然而，对于患者来说，有统计学意义的节省（P=0.02；95%置信区间：-28.98 英镑，3.00 英镑）。当使用 12v1 短期表单测量 ESR 和生活质量的成本和效果措施时，该患者发起的服务并未显示出具有统计学意义的成本效益水平。