Montgomery Carmel L, Thanh Nguyen X, Stelfox Henry T, Norris Colleen M, Rolfson Darryl B, Meyer Steven R, Zibdawi Mohamad A, Bagshaw Sean M
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada.
CJC Open. 2020 Sep 14;3(1):54-61. doi: 10.1016/j.cjco.2020.09.009. eCollection 2021 Jan.
There is limited information about the impact of frailty on public payer costs in cardiac surgery. This study aimed to determine quality-adjusted life-years (QALYs) and costs associated with preoperative frailty in patients referred for cardiac surgery.
We retrospectively compared costs of frailty in a cohort of 529 patients aged ≥ 50 years who were referred for nonemergent cardiac surgery in Alberta. Patients were screened preoperatively for frailty, defined as a score of 5 or greater on the Clinical Frailty Scale. The primary outcome measure was public payer costs attributable to frailty, calculated in a difference-in-difference (DID) model.
The prevalence of frailty was 10% (n = 51; 95% confidence interval [CI], 7%-12%). Median (interquartile range) costs for frail patients were higher in the first year postsurgery ($200,709 [$146,177-$486,852] vs $147,730 [$100,674-$177,025]; < 0.001) compared to nonfrail; the difference-in-difference attributable cost of frailty was $57,836 (95% CI, $-28,608-$144,280). At 1 year, frail patients had fewer QALYs realized compared to nonfrail patients (0.71 [0.57-0.77] vs 0.82 [0.75-0.86], < 0.001), whereas QALYs gained were similar (0.02 [-0.02-0.05] vs 0.02 [0.00-0.04], = 0.58, median difference 0.003 [95% CI, -0.01-0.02]) in frail and nonfrail patients.
Frailty screening identified a population with greater impairment in quality-of-life and greater healthcare costs. Costs attributable to frailty represent opportunity costs that should be considered in future cardiac surgical services planning in the context of our aging population and the growing prevalence of frailty.
关于衰弱对心脏手术公共支付者成本的影响，相关信息有限。本研究旨在确定接受心脏手术患者术前衰弱相关的质量调整生命年（QALY）和成本。
我们回顾性比较了艾伯塔省529名年龄≥50岁、接受非急诊心脏手术患者队列中衰弱的成本。术前对患者进行衰弱筛查，衰弱定义为临床衰弱量表得分≥5分。主要结局指标是采用差分模型计算的因衰弱导致的公共支付者成本。
衰弱患病率为10%（n = 51；95%置信区间[CI]，7%-12%）。与非衰弱患者相比，衰弱患者术后第一年的中位（四分位间距）成本更高（200,709美元[146,177 - 486,852美元]对147,730美元[100,674 - 177,025美元]；P < 0.001）；因衰弱导致的差分成本为57,836美元（95% CI，-28,608美元 - 144,280美元）。术后1年，与非衰弱患者相比，衰弱患者实现的QALY更少（0.71[0.57 - 0.77]对0.82[0.75 - 0.86]，P < 0.001），而衰弱和非衰弱患者获得的QALY相似（0.02[-0.02 - 0.05]对0.02[0.00 - 0.04]，P = 0.58，中位差异0.003[95% CI，-0.01 - 0.02]）。
衰弱筛查识别出生活质量受损更大且医疗成本更高的人群。因衰弱导致的成本代表机会成本，在我们老龄化人口以及衰弱患病率不断上升的背景下，未来心脏手术服务规划中应予以考虑。
