Servei d'Atenció Primària Vallès Occidental, Direcció d'Atenció Primària Metropolitana Nord. Institut Català de la Salut. Sabadell, Barcelona, Spain.
Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), accredited by AGAUR (2017 SGR 917), Barcelona, Spain.
BMC Geriatr. 2021 May 22;21(1):327. doi: 10.1186/s12877-021-02287-7.
Growing evidence shows the effects of psychotropic drugs on the evolution of dementia. Until now, only a few studies have evaluated the cost-effectiveness of psychotropic drugs in institutionalized dementia patients. This study aims to assess the cost-utility of intervention performed in the metropolitan area of Barcelona (Spain) (MN) based on consensus between specialized caregivers involved in the management of dementia patients for optimizing and potentially reducing the prescription of inappropriate psychotropic drugs in this population. This analysis was conducted using the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing (MAFEIP) tool.
The MAFEIP tool builds up from a variety of surrogate endpoints commonly used across different studies in order to estimate health and economic outcomes in terms of incremental changes in quality adjusted life years (QALYs), as well as health and social care utilization. Cost estimates are based on scientific literature and expert opinion; they are direct costs and include medical visits, hospital care, medical tests and exams and drugs administered, among other concepts. The healthcare costs of patients using the intervention were calculated by means of a medication review that compared patients' drug-related costs before, during and after the use of the intervention conducted in MN between 2012 and 2014. The cost-utility analysis was performed from the perspective of a health care system with a time horizon of 12 months.
The tool calculated the incremental cost-effectiveness ratio (ICER) of the intervention, revealing it to be dominant, or rather, better (more effective) and cheaper than the current (standard) care. The ICER of the intervention was in the lower right quadrant, making it an intervention that is always accepted even with the lowest given Willingness to Pay (WTP) threshold value (€15,000).
The results of this study show that the intervention was dominant, or rather, better (more effective) and cheaper than the current (standard) care. This dominant intervention is therefore recommended to interested investors for systematic application.
越来越多的证据表明精神药物对痴呆症的发展有影响。到目前为止，只有少数研究评估了精神药物在机构化痴呆患者中的成本效益。本研究旨在评估巴塞罗那大都市地区（西班牙）（MN）基于参与痴呆症患者管理的专业护理人员之间的共识进行的干预措施的成本效益，目的是优化并潜在减少该人群中不当精神药物的处方。这项分析是使用监测和评估框架（MAFEIP）工具进行的。
MAFEIP 工具建立在各种替代终点的基础上，这些终点通常在不同的研究中使用，以便根据质量调整生命年（QALYs）的增量变化来估计健康和经济结果，以及健康和社会护理的使用。成本估计基于科学文献和专家意见；它们是直接成本，包括医疗访问、医院护理、医疗测试和检查以及药物管理等方面的成本。通过对 2012 年至 2014 年期间在 MN 进行的干预措施使用前后的患者药物相关费用进行药物审查，计算使用该干预措施的患者的医疗费用。成本效益分析从具有 12 个月时间范围的医疗保健系统的角度进行。
该工具计算了干预措施的增量成本效益比（ICER），表明该干预措施具有优势，或者更确切地说，比当前（标准）护理更有效且更便宜。干预措施的 ICER 位于右下象限，这意味着即使在最低的意愿支付（WTP）阈值（15,000 欧元）下，它也是一种始终被接受的干预措施。
这项研究的结果表明，干预措施具有优势，或者更确切地说，比当前（标准）护理更有效且更便宜。因此，建议对此感兴趣的投资者对这种具有优势的干预措施进行系统应用。
