糖尿病健康教练干预对 2 型糖尿病患者的经济学评价：一项基于社区的随机对照试验的单中心评估。

Economic Analysis of a Diabetes Health Coaching Intervention for Adults Living With Type 2 Diabetes: A Single-Centre Evaluation From a Community-Based Randomized Controlled Trial.

机构信息

Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Pharmacy Consulting, Health Benefits Management, TELUS Health, Toronto, Ontario, Canada; Programs for Assessment of Technology in Health, Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.

Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health, Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.

出版信息

Can J Diabetes. 2022 Mar;46(2):165-170. doi: 10.1016/j.jcjd.2021.08.003. Epub 2021 Aug 14.

DOI:10.1016/j.jcjd.2021.08.003

PMID:35115250

Abstract

BACKGROUND

A recent randomized controlled trial demonstrated that a community-based, telephone-delivered diabetes health coaching intervention was effective for improving diabetes management. Our aim in this study was to determine whether this intervention is also cost-effective.

METHODS

An economic evaluation, in the form of a cost-utility analysis (CUA), was used to assess the cost-effectiveness of the coaching intervention from a public payer's perspective. All direct medical costs, as well as intervention implementation, were included. The outcome measure for the CUA was quality-adjusted life-year (QALY). Uncertainty of cost-effectiveness results was estimated using nonparametric bootstraps of patient-level costs and QALYs in the coaching and control arms. A cost-effectiveness acceptability curve was used to express this uncertainty as the probability that diabetes health coaching is cost-effective across a range of values of willingness-to-pay thresholds for a QALY.

RESULTS

The results show that subjects in the coaching arm incurred higher overall costs (in Canadian dollars) than subjects in the control arm ($1,581 vs $1,086, respectively) and incurred 0.02 more QALYs. The incremental cost-effectiveness ratio of the diabetes health coaching intervention compared with usual care was found to be $35,129 per QALY, with probabilities of 67% and 82% that diabetes health coaching would be cost-effective at a willingness-to-pay threshold of $50,000 per QALY and $100,000 per QALY, respectively.

CONCLUSION

A community-based, telephone-delivered diabetes health coaching intervention is cost-effective.

摘要

背景

最近一项随机对照试验表明，基于社区的电话式糖尿病健康辅导干预措施对改善糖尿病管理是有效的。我们在本研究中的目的是确定该干预措施是否同样具有成本效益。

方法

采用成本效用分析（CUA）形式的经济评估，从公共支付者的角度评估辅导干预的成本效益。所有直接医疗费用以及干预实施成本均包括在内。CUA 的结果衡量标准为质量调整生命年（QALY）。通过对辅导组和对照组患者的成本和 QALY 进行非参数自举，估算成本效益结果的不确定性。使用成本效益接受性曲线来表示这种不确定性，即糖尿病健康辅导在一系列意愿支付 QALY 阈值范围内具有成本效益的概率。

结果

结果表明，辅导组的患者总体成本（加元）高于对照组（分别为 1581 加元和 1086 加元），并且获得了 0.02 个额外的 QALY。与常规护理相比，糖尿病健康辅导干预的增量成本效益比为每 QALY35129 加元，在意愿支付阈值分别为 50000 加元和 100000 加元时，糖尿病健康辅导具有成本效益的概率分别为 67%和 82%。