Rosato Rosalba, Pagano Eva, Giordano Andrea, Farinotti Mariangela, Ponzio Michela, Veronese Simone, Confalonieri Paolo, Grasso Maria Grazia, Patti Francesco, Solari Alessandra
Department of Psychology, University of Turin, Turin, Italy; Unit of Clinical Epidemiology, "Città della Salute e della Scienza" Hospital, Turin, Italy and CPO Piemonte, Turin, Italy.
Unit of Clinical Epidemiology, "Città della Salute e della Scienza" Hospital, Turin, Italy and CPO Piemonte, Turin, Italy.
Mult Scler Relat Disord. 2021 Apr;49:102756. doi: 10.1016/j.msard.2021.102756. Epub 2021 Jan 15.
Little is known about the economic consequences of living with severe multiple sclerosis (SMS).
To assess the cost-effectiveness of a home-based palliative approach (HPA) for people with SMS (pwSMS). To assess direct healthcare costs in this population.
PwSMS from three Italian centers received (2:1 ratio) HPA or usual care over six months. Direct healthcare costs were collected on a monthly basis. Incremental cost-effectiveness was gauged from a national healthcare system (NHS) and a personal perspective, considering the Palliative Outcome Scale-Symptoms-MS (POS-S-MS) and the EuroQol five-dimension descriptive system quality-adjusted life years (EQ-5D-3L QALYs), both completed at baseline, after three and six months.
Of 78 randomized pwSMS, 76 (50 HPA, 26 usual care) were analyzed. Mean QALYs were close to zero, and the mean group difference was -0.006 (95% CI -0.057 to 0.044). The mean baseline-adjusted cost difference was € -394 (95% confidence interval, CI -3,532 to 2,743). POS-S-MS cost-effectiveness showed a slight mean reduction of symptom burden (-1.9; 95% CI -1.1 to 5.0) with unchanged costs. Mean direct costs due to MS were € 23,195/year, almost equally distributed between NHS (€ 13,108) and pwSMS (€ 10,087). Personal care, medications and home rehabilitation accounted for 80% of total expenditures. Most personal care costs were covered by pwSMS, and these costs were 3/4 of pwSMS out-of-pocket.
The slight reduction of symptom burden produced by the HPA was not associated with an increase in costs. NHS and pwSMS almost equally sustained these costs.
Current Controlled Trials ISRCTN73082124.
对于重度多发性硬化症(SMS)患者生活所产生的经济后果,人们了解甚少。
评估针对重度多发性硬化症患者(pwSMS)的居家姑息治疗方法(HPA)的成本效益。评估该人群的直接医疗费用。
来自三个意大利中心的重度多发性硬化症患者按2:1的比例接受了为期六个月的居家姑息治疗方法或常规护理。每月收集直接医疗费用。从国家医疗保健系统(NHS)和个人角度衡量增量成本效益,同时考虑姑息治疗结果量表 - 症状 - 多发性硬化症(POS - S - MS)以及欧洲五维健康量表描述系统质量调整生命年(EQ - 5D - 3L QALY),这两个量表均在基线时、三个月后和六个月后完成。
在78名随机分组的重度多发性硬化症患者中,对76名(50名接受居家姑息治疗方法,26名接受常规护理)进行了分析。平均质量调整生命年接近零,组间平均差异为 - 0.006(95%可信区间为-0.057至0.044)。经基线调整后的平均成本差异为-394欧元(95%置信区间,CI为-3532至2743)。POS - S - MS成本效益显示症状负担略有平均减轻(-1.9;95%可信区间为-1.1至5.0),成本未变。多发性硬化症导致的平均直接费用为每年23,195欧元,在国家医疗保健系统(13,108欧元)和重度多发性硬化症患者(10,087欧元)之间几乎平均分配。个人护理、药物和家庭康复占总支出的8%。大多数个人护理费用由重度多发性硬化症患者承担,这些费用占重度多发性硬化症患者自付费用的3/4。
居家姑息治疗方法所带来的症状负担略有减轻与成本增加无关。国家医疗保健系统和重度多发性硬化症患者几乎平均承担了这些费用。
当前对照试验ISRCTN73082124 。