Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston Road, Herston, Qld 4029, Australia; and Corresponding authors. Email:
Centre for Applied Health Economics, Sir Samuel Griffith Centre, Griffith University, Nathan, Qld 4111, Australia. Email:
Aust Health Rev. 2021 Feb;45(1):42-50. doi: 10.1071/AH19226.
Objective This study compared the cost of an integrated primary-secondary care general practitioner (GP)-based Beacon model with usual care at hospital outpatient departments (OPDs) for patients with complex type 2 diabetes. Methods A costing analysis was completed alongside a non-inferiority randomised control trial. Costs were calculated using information from accounting data and interviews with clinic managers. Two OPDs and three GP-based Beacon practices participated. In the Beacon practices, GPs with a special interest in advanced diabetes care worked with an endocrinologist and diabetes nurse educator to care for referred patients. The main outcome was incremental cost saving per patient course of treatment from a health system perspective. Uncertainty was characterised with probabilistic sensitivity analysis using Monte Carlo simulation. Results The Beacon model is cost saving: the incremental cost saving per patient was A$365 (95% confidence interval -A$901, A$55) and was cost saving in 93.7% of simulations. The key contributors to the variance in the cost saving per patient course of treatment were the mean number of patients seen per site and the number of additional presentations per course of treatment associated with the Beacon model. Conclusions Beacon clinics were less costly per patient course of treatment than usual care in hospital OPDs for equivalent clinical outcomes. Local contractual arrangements and potential variation in the operational cost structure are of significant consideration in determining the cost-efficiency of Beacon models. What is known about this topic? Despite the growing importance of achieving care quality within constrained budgets, there are few costing studies comparing clinically-equivalent hospital and community-based care models. What does this paper add? Costing analyses comparing hospital-based to GP-based health services require considerable effort and are complex. We show that GP-based Beacon clinics for patients with complex chronic disease can be less costly per patient course of treatment than usual care offered in hospital OPDs. What are the implications for practitioners? In addition to improving access and convenience for patients, transferring care from hospital to the community can reduce health system costs.
目的 本研究比较了综合初级-二级保健家庭医生（GP）为基础的 Beacon 模式与医院门诊部门（OPD）常规护理对 2 型糖尿病复杂患者的成本。
方法 成本分析是在非劣效性随机对照试验的同时进行的。使用会计数据和与诊所经理的访谈信息来计算成本。有两个 OPD 和三个基于 GP 的 Beacon 诊所参与。在 Beacon 诊所中，对高级糖尿病护理有特殊兴趣的家庭医生与内分泌学家和糖尿病护士教育者合作，为转诊患者提供护理。主要结局是从卫生系统角度来看，每位患者治疗过程中的增量成本节约。使用蒙特卡罗模拟进行概率敏感性分析来描述不确定性。
结果 Beacon 模式具有成本节约性：每位患者的增量成本节约为 365 澳元（95%置信区间 -901 澳元，55 澳元），在 93.7%的模拟中具有成本节约性。治疗过程中每位患者成本节约的主要贡献因素是每个站点就诊的平均患者人数和 Beacon 模式相关的每个疗程额外就诊次数。
结论 Beacon 诊所的每位患者治疗成本比医院 OPD 的常规护理低，同时具有等效的临床效果。确定 Beacon 模式的成本效益时，需要考虑当地的合同安排和运营成本结构的潜在变化。
关于这个话题，你知道些什么？尽管在有限的预算内实现护理质量的重要性日益增加，但很少有成本研究比较具有临床等效性的医院和社区护理模式。这篇论文增加了什么？与医院相比，比较基于 GP 的卫生服务的成本分析需要付出相当大的努力，并且非常复杂。我们表明，对于复杂的慢性疾病患者，基于 GP 的 Beacon 诊所每疗程的治疗成本可能比医院 OPD 提供的常规护理低。
这对从业者有什么影响？除了为患者提供更好的就诊机会和便利性外，将护理从医院转移到社区还可以降低卫生系统的成本。
