基于家庭的运动方案对老年认知障碍患者的成本效益和成本效用研究

Cost-Effectiveness and Cost-Utility of a Home-Based Exercise Program in Geriatric Patients with Cognitive Impairment.

机构信息

Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg, Heidelberg, Germany.

Karlsruhe Institute of Technology (KIT), Institute of Sport and Sport Science, Karlsruhe, Germany.

出版信息

Gerontology. 2021;67(2):220-232. doi: 10.1159/000512748. Epub 2021 Jan 27.

DOI:10.1159/000512748

PMID:33503629

Abstract

INTRODUCTION

There is a substantial lack of home-based exercise programs in the highly vulnerable group of geriatric patients with cognitive impairment (CI) after discharge from ward rehabilitation. Beyond clinical effectiveness, the cost-effectiveness of intervention programs to enhance physical performance is not well investigated in this target group.

OBJECTIVE

The aim of the study was to determine the cost-effectiveness of a 12-week home-based exercise intervention following discharge from ward rehabilitation compared to unspecified flexibility training for geriatric patients with CI from a societal perspective.

METHODS

This cost-effectiveness study was conducted alongside a randomized placebo-controlled trial. A total of 118 geriatric patients with CI (Mini-Mental State Examination score: 17-26) were randomized either to the intervention group (IG, n = 63) or control group (CG, n = 55). Participants in the IG received a home-based individually tailored exercise program to increase physical performance, while participants in the CG received unspecific flexibility training (placebo control). Healthcare service use, physical performance (Short Physical Performance Battery, SPPB), and quality of life (EQ-5D-3L) were measured over 24 weeks. The net monetary benefit (NMB) approach was applied to calculate incremental cost-effectiveness of the exercise intervention compared to the CG with respect to improvement of (a) physical performance on the SPPB and (b) quality-adjusted life years (QALYs).

RESULTS

Physical performance was significantly improved in the IG compared to the CG (mean difference at 24 weeks: 1.3 points; 95% confidence interval [95% CI] = 0.5-2.2; p = 0.003), while health-related quality of life did not significantly differ between the groups at 24 weeks (mean difference: 0.08; 95% CI = -0.05 to 0.21; p = 0.218). Mean costs to implement the home-based exercise intervention were EUR 284 per patient. The probability of a positive incremental NMB of the intervention reached a maximum of 92% at a willingness to pay (WTP) of EUR 500 per point on the SPPB. The probability of cost-utility referring to QALYs was 85% at a WTP of EUR 5,000 per QALY.

CONCLUSION

The home-based exercise intervention demonstrated high probability of cost-effectiveness in terms of improved physical performance in older adults with CI following discharge from ward rehabilitation, but not in terms of quality of life.

摘要

简介

在从病房康复中出院的认知障碍（CI）老年患者这一高度脆弱群体中，家庭为基础的锻炼计划严重缺乏。除了临床效果外，针对这一目标群体的增强身体表现的干预计划的成本效益也没有得到很好的研究。

目的

本研究旨在从社会角度确定与未指定的灵活性训练相比，对从病房康复出院后的认知障碍老年患者进行为期 12 周的家庭为基础的锻炼干预的成本效益。

方法

本成本效益研究是与一项随机安慰剂对照试验同时进行的。共有 118 名认知障碍（简易精神状态检查得分：17-26）的老年患者被随机分为干预组（IG，n=63）或对照组（CG，n=55）。IG 组的参与者接受了一项家庭为基础的个性化锻炼计划，以提高身体表现，而 CG 组的参与者接受了非特异性的灵活性训练（安慰剂对照）。在 24 周内测量了医疗保健服务的使用、身体表现（简短身体表现电池，SPPB）和生活质量（EQ-5D-3L）。应用净货币效益（NMB）方法来计算与 CG 相比，运动干预在改善（a）SPPB 上的身体表现和（b）质量调整生命年（QALYs）方面的增量成本效益。

结果

与 CG 相比，IG 的身体表现明显改善（24 周时的平均差异：1.3 分；95%置信区间[95%CI]为 0.5-2.2；p=0.003），而两组在 24 周时的健康相关生活质量没有显著差异（平均差异：0.08；95%CI=0.05-0.21；p=0.218）。实施家庭为基础的锻炼干预的平均费用为每位患者 284 欧元。在对 SPPB 每点 500 欧元的支付意愿（WTP）下，干预的增量 NMB 呈正的概率最高达到 92%。在对 QALYs 每 QALY 5000 欧元的 WTP 下，成本效益参照 QALYs 的概率为 85%。