School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
PLoS One. 2022 Apr 7;17(4):e0266464. doi: 10.1371/journal.pone.0266464. eCollection 2022.
COVID-19 pandemic burdens the healthcare systems, causes healthcare avoidance, and might worsen the outcomes of inflammatory bowel disease (IBD) management. We aimed to estimate the impact of pandemic-related avoidance on outpatient IBD management, and the cost-effectiveness of adding telemonitoring during pandemic from the perspective of Hong Kong public healthcare provider.
The study was performed by a decision-analytic model to estimate the quality-adjusted life-years (QALYs) and cost of care for IBD patients before and during the pandemic, and to compare the cost and QALYs of adding telemonitoring to standard care (SC-TM) versus standard care alone (SC) for IBD patients during the pandemic. The sources of model inputs included publications (retrieved from literature search) and public data. Sensitivity analyses were conducted to examine the robustness of base-case results.
Standard care with pandemic-related avoidance (versus without avoidance) lost 0.0026 QALYs at higher cost (by USD43). The 10,000 Monte Carlo simulations found standard care with pandemic-related avoidance lost QALYs and incurred higher cost in 100% and 96.82% of the time, respectively. Compared with the SC group, the SC-TM group saved 0.0248 QALYs and reduced cost by USD799. Monte Carlo simulations showed the SC-TM group gained higher QALYs at lower cost in 100% of 10,000 simulations.
Standard care for IBD patients during pandemic with healthcare avoidance appears to worsen treatment outcomes at higher cost and lowered QALYs. The addition of telemonitoring to standard care seems to gain higher QALYs and reduce cost, and is therefore a potential cost-effective strategy for IBD management during the pandemic.
新冠疫情对医疗系统造成了负担，导致人们回避医疗服务，可能会使炎症性肠病（IBD）的管理结果恶化。本研究旨在评估疫情相关回避对门诊 IBD 管理的影响，以及从香港公营医疗服务提供者的角度来看，在疫情期间增加远程监测的成本效益。
本研究采用决策分析模型，估算 IBD 患者在疫情前后的质量调整生命年（QALYs）和医疗费用，并比较在疫情期间，为 IBD 患者提供标准护理（SC-TM）与单纯标准护理（SC）的成本效益。模型输入的来源包括出版物（通过文献检索获得）和公共数据。进行敏感性分析以检验基础案例结果的稳健性。
与无回避相比，有疫情相关回避的标准护理（versus without avoidance）在更高的成本下损失了 0.0026 个 QALYs（增加了 43 美元）。10000 次蒙特卡罗模拟发现，有疫情相关回避的标准护理在 100%和 96.82%的情况下损失了 QALYs 并增加了成本。与 SC 组相比，SC-TM 组节省了 0.0248 个 QALYs，降低了 799 美元的成本。蒙特卡罗模拟显示，在 10000 次模拟中的 100%，SC-TM 组以更低的成本获得了更高的 QALYs。
在疫情期间，对 IBD 患者进行有医疗回避的标准护理似乎会在更高的成本和降低的 QALYs 下恶化治疗结果。将远程监测添加到标准护理中似乎可以获得更高的 QALYs 并降低成本，因此，这是疫情期间 IBD 管理的一种潜在的成本效益策略。
