荷兰初级医疗中儿童急性中耳炎的成本：一项整群随机对照试验的经济分析
Cost of childhood acute otitis media in primary care in the Netherlands: economic analysis alongside a cluster randomised controlled trial.
作者信息
van Uum Rick T, Venekamp Roderick P, Pasmans Clémence T B, de Wit G Ardine, Sjoukes Alies, van der Pol Alma C, Damoiseaux Roger A M J, Schilder Anne G M
机构信息
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
出版信息
BMC Health Serv Res. 2021 Mar 4;21(1):193. doi: 10.1186/s12913-021-06157-1.
BACKGROUND
Acute otitis media (AOM) is among the most common paediatric conditions managed in primary care. Most recent estimates of the cost of AOM date from a decade ago and lack a full societal perspective. We therefore explored the societal cost of childhood AOM in the Netherlands within the setting of a trial comparing the effectiveness of an intervention aimed at educating general practitioners (GPs) about pain management in AOM compared to usual care.
METHODS
Economic analysis alongside a cluster randomised controlled trial conducted between February 2015 and May 2018 in 37 practices (94 GPs). In total, 224 children with AOM were included of which 223 (99%) completed the trial (intervention: n = 94; control: n = 129). The cost of AOM due to health care costs, patient and family costs, and productivity losses by parent caregivers were retrieved from study diaries and primary care electronic health records, during 28-day follow-up. We calculated mean cost (€ and $) per AOM episode per patient with standard deviations (SD, in €) regardless of study group assignment because there was no clinical effect of the trial intervention. In sensitivity analysis, we calculated cost in the intervention and usual care group, after exclusion of extreme outliers.
RESULTS
Mean total AOM cost per patient were €565.93 or $638.78 (SD €1071.01); nearly 90% of these costs were due to productivity losses experienced by parents. After exclusion of outliers, AOM cost was €526.70 or $594.50 (SD €987.96) and similar in the intervention and usual care groups: €516.10 or $582.53 (SD €949.69) and €534.55 or $603.36 (SD €920.55) respectively.
CONCLUSIONS
At €566 or $639 per episode, societal cost of AOM is higher than previously known and mainly driven by productivity losses by children's parents. Considering its high incidence, AOM poses a significant economic burden that extends beyond direct medical costs.
TRIAL REGISTRATION
Netherlands Trial Register no. NTR4920: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4920 .
背景
急性中耳炎（AOM）是基层医疗中最常见的儿科疾病之一。最近对AOM成本的估计可追溯到十年前，且缺乏全面的社会视角。因此，我们在一项试验背景下探讨了荷兰儿童AOM的社会成本，该试验比较了一项旨在对全科医生（GPs）进行AOM疼痛管理教育的干预措施与常规护理的有效性。
方法
在2015年2月至2018年5月期间，对37家医疗机构（94名全科医生）进行了经济分析，并开展了一项整群随机对照试验。总共纳入了224名AOM患儿，其中223名（99%）完成了试验（干预组：n = 94；对照组：n = 129）。在28天的随访期间，从研究日记和基层医疗电子健康记录中获取了因医疗保健成本、患者及家庭成本以及家长照顾者的生产力损失而导致的AOM成本。我们计算了每名患者每次AOM发作的平均成本（欧元和美元）及标准差（以欧元为单位的SD），不考虑研究组分配情况，因为试验干预没有临床效果。在敏感性分析中，我们排除极端异常值后计算了干预组和常规护理组的成本。
结果
每名患者AOM的平均总成本为565.93欧元或638.78美元（标准差1071.01欧元）；其中近90%的成本是由于家长的生产力损失。排除异常值后，AOM成本为526.70欧元或594.50美元（标准差987.96欧元），干预组和常规护理组相似：分别为516.10欧元或582.53美元（标准差949.69欧元）和534.55欧元或603.36美元（标准差920.55欧元）。
结论
AOM的社会成本为每次发作566欧元或639美元，高于此前所知，且主要由儿童家长的生产力损失驱动。鉴于其高发病率，AOM构成了重大的经济负担，其影响超出了直接医疗成本。
试验注册
荷兰试验注册编号NTR4920：http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4920 。
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