Agarwal Gina, Pirrie Melissa, Angeles Ricardo, Marzanek Francine, Thabane Lehana, O'Reilly Daria
Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
BMJ Open. 2020 Oct 27;10(10):e037386. doi: 10.1136/bmjopen-2020-037386.
To evaluate the cost-effectiveness of the Community Paramedicine at Clinic (CP@clinic) programme compared with usual care in seniors residing in subsidised housing.
A cost-utility analysis was conducted within a large pragmatic cluster randomised controlled trial (RCT). Subsidised housing buildings were matched by sociodemographics and location (rural/urban), and allocated to intervention (CP@clinic for 1 year) or control (usual care) via computer-assisted paired randomisation.
Thirty-two subsidised seniors' housing buildings in Ontario.
Building residents 55 years and older.
CP@clinic is a weekly community paramedic-led, chronic disease prevention and health promotion programme in the building common areas. CP@clinic is free to residents and includes risk assessments, referrals to resources, and reports back to family physicians.
Quality-adjusted life years (QALYs) gained, measured with EQ-5D-3L. QALYs were estimated using area-under-the curve over the 1-year intervention, controlling for preintervention utility scores and building pairings. Programme cost data were collected before and during implementation. Costs associated with emergency medical services (EMS) use were estimated. An incremental cost effectiveness ratio (ICER) based on incremental costs and health outcomes between groups was calculated. Probabilistic sensitivity analysis using bootstrapping was performed.
The RCT included 1461 residents; 146 and 125 seniors completed the EQ-5D-3L in intervention and control buildings, respectively. There was a significant adjusted mean QALY gain of 0.03 (95% CI 0.01 to 0.05) for the intervention group. Total programme cost for implementing in five communities was $C128 462 and the reduction in EMS calls avoided an estimated $C256 583. The ICER was $C2933/QALY (bootstrapped mean ICER with Fieller's 95% CI was $4850 ($2246 to $12 396)) but could be even more cost effective after accounting for the EMS call reduction.
The CP@clinic ICER was well below the commonly used Canadian cost-utility threshold of $C50 000. CP@clinic scale-up across subsidised housing is feasible and could result in better health-related quality-of-life and reduced EMS use in low-income seniors.
Clinicaltrials.gov, NCT02152891.
评估社区诊所护理辅助计划（CP@clinic）相较于为居住在保障性住房中的老年人提供的常规护理的成本效益。
在一项大型实用整群随机对照试验（RCT）中进行成本效用分析。保障性住房建筑按社会人口统计学和位置（农村/城市）进行匹配，并通过计算机辅助配对随机化分配至干预组（接受为期1年的CP@clinic计划）或对照组（常规护理）。
安大略省的32栋保障性老年人住房建筑。
55岁及以上的建筑居民。
CP@clinic是一项由社区护理辅助人员每周在建筑公共区域主导开展的慢性病预防和健康促进计划。该计划对居民免费，包括风险评估、资源转介以及向家庭医生反馈情况。
使用EQ-5D-3L量表测量获得的质量调整生命年（QALY）。通过1年干预期间的曲线下面积估算QALY，同时控制干预前的效用得分和建筑配对情况。在计划实施前和实施期间收集计划成本数据。估算与使用紧急医疗服务（EMS）相关的成本。计算基于两组之间增量成本和健康结局的增量成本效益比（ICER）。使用自抽样法进行概率敏感性分析。
该RCT纳入了1461名居民；分别有146名和125名老年人在干预组和对照组建筑中完成了EQ-5D-3L量表测评。干预组调整后的平均QALY显著增加了0.03（95%置信区间为0.01至0.05）。在五个社区实施该计划的总成本为128,462加元，EMS呼叫次数的减少估计节省了256,583加元。ICER为2933加元/QALY（自抽样法得出的平均ICER及Fieller 95%置信区间为4850加元（2246加元至12,396加元）），但在考虑EMS呼叫次数减少后可能更具成本效益。
CP@clinic的ICER远低于加拿大常用的50,000加元成本效用阈值。在保障性住房中扩大CP@clinic计划的规模是可行的，并且可能会改善低收入老年人与健康相关的生活质量并减少EMS的使用。
Clinicaltrials.gov，NCT02152891。
