Liu Hongpeng, Zhu Dawei, Song Baoyun, Jin Jingfen, Liu Yilan, Wen Xianxiu, Cheng Shouzhen, Nicholas Stephen, Wu Xinjuan
Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China.
China Center for Health Development Studies, Peking University, No.38, Xueyuan Road, Haidian District, Beijing 100191, China.
Int J Nurs Stud. 2020 Oct;110:103703. doi: 10.1016/j.ijnurstu.2020.103703. Epub 2020 Jul 2.
While a nursing intervention program for immobile patients with stroke can improve clinic outcomes, less is known about the cost-effectiveness of these interventions.
The goal of this study was to evaluate the cost-effectiveness of the intervention program for immobile patients with stroke in China.
A cost-effectiveness analysis alongside a pre-test/post-test (before and after) study was undertaken from a health care perspective.
Participants were recruited from 25 hospitals among six provinces or municipal cities in eastern (Guangdong province, Zhejiang province, and Beijing municipal city), western (Sichuan province), and central (Henan province and Hubei province) China.
A total of 7,653 immobile stroke patients were included in our sample. Patients in routine care settings were recruited from November 2015 to June 2016, and the recruitment of the intervention group patients was from November 2016 to July 2017.
To adjust for potential bias from confounding variables, the 1:1 propensity score matching yielded matched pairs of 2,966 patients in the routine care group and 2,966 patients in the intervention group, with no significant differences in sociodemographic or clinical characteristics between two groups. All patients were followed-up 3 months after enrolment in the study. Total healthcare costs were extracted from the hospital information system, with the health outcome effectiveness of the intervention program measured using the EuroQol five-dimensional questionnaire (EQ-5D) instrument and the cost-effectiveness of the intervention measured by the incremental cost-effectiveness ratio with a time horizon of 3 months.
Compared to routine care, the intervention program decreased the total costs of stroke patients by CN¥4,600 (95% confidence interval [CI]: [-7050, -2151]), while increasing quality-adjusted life year 0.009 (95% CI: [0.005, 0.013]). The incremental cost-effectiveness ratios over 3 months was CN¥-517,011 per quality-adjusted life year (95% CI: [-1,111,442, -203,912]). Subgroup analysis reveals that both the health-related quality of life and cost effectiveness improved significantly for ischemic patients and tertiary hospitals patients while for hemorrhagic patients and non-tertiary hospital patients only the health-related quality of life improved significantly.
Findings from this first cost-effectiveness analysis in immobile stroke patients provide evidence that an intervention program provided significant cost saving, but mainly in ischemic patients and tertiary hospital patients. Wider adoption of such programs may be a sensible approach to reducing the burden of stroke and for immobile patients more generally.
虽然针对中风后行动不便患者的护理干预计划可改善临床结局，但对于这些干预措施的成本效益了解较少。
本研究的目的是评估中国针对中风后行动不便患者的干预计划的成本效益。
从医疗保健角度进行了一项成本效益分析以及一项前后测（干预前后）研究。
参与者来自中国东部（广东省、浙江省和北京市）、西部（四川省）和中部（河南省和湖北省）六个省或直辖市的25家医院。
我们的样本共纳入7653例中风后行动不便患者。常规护理组的患者于2015年11月至2016年6月招募，干预组患者于2016年11月至2017年7月招募。
为了调整混杂变量可能产生的偏差，采用1:1倾向得分匹配法，在常规护理组和干预组分别得到2966对匹配患者，两组在社会人口统计学或临床特征方面无显著差异。所有患者在纳入研究3个月后进行随访。从医院信息系统中提取总医疗费用，使用欧洲五维健康量表（EQ-5D）工具测量干预计划的健康结局有效性，并以3个月为时间跨度，通过增量成本效益比来衡量干预措施的成本效益。
与常规护理相比，干预计划使中风患者的总费用降低了4600元人民币（95%置信区间[CI]：[-7050，-2151]），同时使质量调整生命年增加了0.009（95%CI：[0.005，0.013]）。3个月的增量成本效益比为每质量调整生命年-517,011元人民币（95%CI：[-1,111,442，-203,912]）。亚组分析显示，缺血性中风患者和三级医院患者的健康相关生活质量和成本效益均显著改善，而出血性中风患者和非三级医院患者仅健康相关生活质量显著改善。
这项针对中风后行动不便患者的首次成本效益分析结果表明，干预计划可显著节省成本，但主要体现在缺血性中风患者和三级医院患者中。更广泛地采用此类计划可能是减轻中风负担以及更普遍地减轻行动不便患者负担的明智方法。
