Sangarapillai Tarsan, Hajizadeh Mohammad, Daskalopoulou Stella S, Dasgupta Kaberi
Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.
CJC Open. 2021 May 1;3(8):1043-1050. doi: 10.1016/j.cjco.2021.04.009. eCollection 2021 Aug.
Increments of 1000 steps/d predict cardiovascular disease (CVD) event reductions. In adults with type 2 diabetes and/or hypertension, our tep onitoring to Improve ial Health (SMARTER) trial demonstrated a physician-delivered step-count prescription strategy to increase steps by more than this amount over 1 year, compared to usual care. In the present analysis, we aimed to determine the costs of the intervention compared to usual care, incorporating 1-year intervention costs and projected savings from lower CVD hospitalizations over the subsequent 5 years.
We considered Canadians aged 55 to 74 years with type 2 diabetes and/or hypertension. Using time estimates from our trial, we computed nursing costs corresponding to patient support time over 1 year, and pedometer costs for an anticipated 50% of patients without a smartphone. We estimated the number of CVD hospitalizations, the reduction expected with a mean 1000 steps/d increase, and the associated savings. We calculated the net cost (savings), the proportion of patients with their own device required for cost neutrality, and costs (savings) if all patients needed to be provided with a device.
At an average intervention cost of $51.28/patient, the total cost would be $168 million. With an estimated 8875 CVD events prevented, $208 million would be saved. This savings would result in ~$40 million in net savings with 50% device ownership, cost neutrality with 25% device ownership, and ~$42 million in net costs if all patients required the healthcare system to provide a device.
At current levels of smartphone ownership, adoption of the SMARTER strategy is cost-saving to cost-neutral from the healthcare system perspective.
每天增加1000步可预测心血管疾病（CVD）事件减少。在患有2型糖尿病和/或高血压的成年人中，我们的“通过步数监测改善健康（SMARTER）”试验表明，与常规护理相比，由医生提供的步数处方策略可在1年内使步数增加超过此数量。在本分析中，我们旨在确定与常规护理相比该干预措施的成本，纳入1年的干预成本以及随后5年因CVD住院减少而预计节省的费用。
我们纳入了年龄在55至74岁之间患有2型糖尿病和/或高血压的加拿大人。利用我们试验中的时间估计值，我们计算了与1年患者支持时间相对应的护理成本，以及预计50%没有智能手机的患者的计步器成本。我们估计了CVD住院的数量、平均每天增加1000步预期减少的数量以及相关的节省费用。我们计算了净成本（节省费用）、成本持平所需拥有自己设备的患者比例，以及如果所有患者都需要提供设备时的成本（节省费用）。
平均干预成本为每位患者51.28美元，总成本将为1.68亿美元。估计可预防8875例CVD事件，可节省2.08亿美元。如果50%的患者拥有设备，这笔节省将导致约4000万美元的净节省；如果25%的患者拥有设备，则成本持平；如果所有患者都需要医疗系统提供设备，则净成本约为4200万美元。
从医疗系统的角度来看，在当前智能手机拥有水平下，采用SMARTER策略从节省成本到成本持平。
