González-Guerrero José L, Hernández-Mocholi Miguel A, Ribera-Casado José M, García-Mayolín Nieves, Alonso-Fernández Teresa, Gusi Narcís
Geriatric Service, Complejo Hospitalario de Cáceres, Cáceres, Spain.
Faculty of Sports Sciences, University of Extremadura, Av. Universidad S/N, 10003, Cáceres, Spain.
Eur Geriatr Med. 2018 Aug;9(4):523-532. doi: 10.1007/s41999-018-0074-y. Epub 2018 Jun 6.
To assess the cost-utility of adding a disease management program (DMP) delivered by geriatric day hospital (GDH) for older patients with heart failure (HF) after hospital discharge.
117 older HF patients discharged by a geriatric service were randomly assigned to DMP (n = 59) and usual care (UC) (n = 58) groups. The DMP group received health education, therapeutic control and monitoring through both telephone contacts and face-to-face visits at the GDH for 12 months. The UC group received standard health care. The main outcome measures were the costs from the health-care system and societal perspectives and quality-adjusted life-years (QALYs) using EuroQol (EQ-5D-3L). The cost-effectiveness analysis used the package ICEinfer in R 2.13.0.
The mean age was 85 years, and 73% of the patients were women. The mean values of QALYs after 12 months were - 0.083 in DMP and - 0.154 in UC. Each extra QALY gained by the DMP relative to usual care cost was €38,274 and €25,390 from health-care or societal perspective, respectively. An investment of €44,000/QALY (Spanish Health System Threshold) showed a 91 and 85% of probability to be cost-effective from health-care and societal perspectives.
The intervention was moderately cost-effective in delaying deaths and preserving the loss of health-related quality of life in older patients with HF. The study was internationally registered with the ISRCTN10823032.
评估老年日间医院（GDH）为出院后的老年心力衰竭（HF）患者提供疾病管理计划（DMP）的成本效益。
117名由老年服务机构出院的老年HF患者被随机分为DMP组（n = 59）和常规护理（UC）组（n = 58）。DMP组通过电话联系和在GDH进行面对面访视，接受为期12个月的健康教育、治疗控制和监测。UC组接受标准医疗保健。主要结局指标是从医疗保健系统和社会角度的成本以及使用欧洲五维度健康量表（EQ - 5D - 3L）的质量调整生命年（QALYs）。成本效益分析使用R 2.13.0中的ICEinfer软件包。
平均年龄为85岁，73%的患者为女性。12个月后QALYs的平均值在DMP组为 - 0.083，在UC组为 - 0.154。从医疗保健或社会角度来看，DMP相对于常规护理每多获得一个QALY的成本分别为38,274欧元和25,390欧元。以44,000欧元/QALY（西班牙卫生系统阈值）进行投资，从医疗保健和社会角度来看，具有成本效益的概率分别为91%和85%。
该干预措施在延迟老年HF患者死亡和维持与健康相关的生活质量损失方面具有中等成本效益。该研究已在国际上以ISRCTN10823032进行注册。
