系统地将肿瘤治疗快速过渡到家庭专科姑息治疗的成本效益分析：DOMUS 试验。
Cost-effectiveness analysis of systematic fast-track transition from oncological treatment to specialised palliative care at home for patients and their caregivers: the DOMUS trial.
机构信息
VIVE - The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, København K, Denmark.
Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
出版信息
BMC Palliat Care. 2020 Sep 15;19(1):142. doi: 10.1186/s12904-020-00645-7.
BACKGROUND
While hospitals remain the most common place of death in many western countries, specialised palliative care (SPC) at home is an alternative to improve the quality of life for patients with incurable cancer. We evaluated the cost-effectiveness of a systematic fast-track transition process from oncological treatment to SPC enriched with a psychological intervention at home for patients with incurable cancer and their caregivers.
METHODS
A full economic evaluation with a time horizon of six months was performed from a societal perspective within a randomised controlled trial, the DOMUS trial ( Clinicaltrials.gov : NCT01885637). The primary outcome of the health economic analysis was a incremental cost-effectiveness ratio (ICER), which is obtained by comparing costs required per gain in Quality-Adjusted Life Years (QALY). The costs included primary and secondary healthcare costs, cost of intervention and informal care from caregivers. Public transfers were analysed in seperate analysis. QALYs were measured using EORTC QLQ-C30 for patients and SF-36 for caregivers. Bootstrap simulations were performed to obtain the ICER estimate.
RESULTS
In total, 321 patients (162 in intervention group, 159 in control group) and 235 caregivers (126 in intervention group, 109 in control group) completed the study. The intervention resulted in significantly higher QALYs for patients when compared to usual care (p-value = 0.026), while being more expensive as well. In the 6 months observation period, the average incremental cost of intervention compared to usual care was €2015 per patient (p value < 0.000). The mean incremental gain was 0.01678 QALY (p-value = 0.026). Thereby, the ICER was €118,292/QALY when adjusting for baseline costs and quality of life. For the caregivers, we found no significant differences in QALYs between the intervention and control group (p-value = 0.630). At a willingness to pay of €80,000 per QALY, the probability that the intervention is cost-effective lies at 15% in the base case scenario.
CONCLUSION
This model of fast-track SPC enriched with a psychological intervention yields better QALYs than usual care with a large increase in costs.
TRIAL REGISTRATION
The trial was prospectively registered 25.6.2013. Clinicaltrials.gov Identifier: NCT01885637 .
背景
尽管在许多西方国家医院仍是最常见的死亡地点，但在家中进行专门的姑息治疗（SPC）是一种改善绝症患者生活质量的替代方法。我们评估了一种系统的快速通道过渡过程的成本效益，该过程从肿瘤治疗过渡到在家中进行 SPC，并辅以心理干预，适用于绝症癌症患者及其护理人员。
方法
在一项随机对照试验 DOMUS 试验（Clinicaltrials.gov：NCT01885637）中，从社会角度进行了全面的经济评估，时间范围为六个月。卫生经济学分析的主要结果是增量成本效益比（ICER），通过比较每获得一个质量调整生命年（QALY）所需的成本来获得。成本包括初级和二级医疗保健成本、干预成本和护理人员的非正式护理成本。公共转移在单独的分析中进行了分析。使用 EORTC QLQ-C30 对患者和 SF-36 对护理人员进行 QALY 测量。通过引导模拟获得 ICER 估计值。
结果
共有 321 名患者（干预组 162 名，对照组 159 名）和 235 名护理人员（干预组 126 名，对照组 109 名）完成了研究。与常规护理相比，干预组患者的 QALY 显著更高（p 值=0.026），同时成本也更高。在 6 个月的观察期内，与常规护理相比，干预的平均增量成本为每位患者 2015 欧元（p 值<0.000）。平均增量收益为 0.01678 QALY（p 值=0.026）。因此，当调整基线成本和生活质量时，ICER 为 118292 欧元/QALY。对于护理人员，我们发现干预组和对照组之间的 QALY 没有显著差异（p 值=0.630）。在支付意愿为 80000 欧元/QALY 的情况下，干预措施具有成本效益的概率在基础案例中为 15%。
结论
这种快速通道 SPC 模型辅以心理干预，比常规护理产生更好的 QALY，但成本大幅增加。
试验注册
该试验于 2013 年 6 月 25 日进行了前瞻性注册。Clinicaltrials.gov 标识符：NCT01885637。
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