帕金森氏 KinetiGraph 的成本效益分析及其在帕金森病管理中的临床评估。

Cost-effectiveness analysis of the Parkinson's KinetiGraph and clinical assessment in the management of Parkinson's disease.

机构信息

Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, and. Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom.

Newcastle Upon Tyne Hospitals NHS Foundation Trust, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom.

出版信息

J Med Econ. 2022 Jan-Dec;25(1):774-782. doi: 10.1080/13696998.2022.2080437.

DOI:10.1080/13696998.2022.2080437

PMID:35593687

Abstract

AIMS

The Parkinson's KinetiGraph (PKG) is a wrist-worn movement recording system that collates continuous, objective, data during daily activities in people with Parkinson's disease (PD) providing a report for clinicians. This study explores the cost-effectiveness of adding the PKG to routine PD assessments.

METHODS

A de novo Markov model of three health states: uncontrolled, controlled and death compared PKG plus routine assessment by a Movement Disease Specialist (MDS) versus routine assessment. Uncontrolled and controlled states were based on the Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) II and III scores. The transition between health states was dependent on improvement in MDS-UPDRS II and III, and transition to death state on all cause-mortality and PD-specific relative mortality risk. Markov cycle length was yearly beyond year 1 and lifetime horizon 22 years.

LIMITATIONS

PKG evidence incorporated in this analysis is based on findings from one clinical trial. Health state utilities were mapped and the probability of patients progressing from uncontrolled to controlled health state at the second visit and beyond was derived from a bootstrap method which assumed a normal distribution for MDS-UPDRS.

RESULTS

The addition of the PKG to usual PD assessments is a cost-effective intervention. PKG plus routine assessment is associated with lower total costs compared to routine assessment (£141,950 versus £159,312) and improved quality-adjusted life years (7.88 versus 7.61), resulting in an incremental cost-effectiveness ratio of -£64,978.99 and a net monetary benefit of £22,706.37 using a £20,000 threshold. Results were robust across sensitivity and scenario analyses.

CONCLUSIONS

Management of PD involves monitoring and evaluation of symptoms to assess disease progression and ensure appropriate treatment choices. Adding the PKG to clinical assessment in routine care allows for improved and objective identification of PD motor symptoms which can be used in clinical decision making to improve patient outcomes.

摘要

目的

帕金森运动图（PKG）是一种可穿戴于手腕的运动记录系统，可在帕金森病（PD）患者的日常活动中连续、客观地收集数据，为临床医生提供报告。本研究探讨了在常规 PD 评估中添加 PKG 的成本效益。

方法

采用三个健康状态的新马尔可夫模型：未控制、控制和死亡，比较 PKG 加运动障碍协会专家（MDS）常规评估与常规评估。未控制和控制状态基于运动障碍协会-统一帕金森病评定量表（MDS-UPDRS）Ⅱ和Ⅲ评分。健康状态之间的转换取决于 MDS-UPDRS Ⅱ和Ⅲ的改善，以及所有原因死亡率和 PD 特异性相对死亡率风险导致的死亡状态的转换。马尔可夫循环长度在第 1 年后为每年，22 年的终生视野。

局限性

本分析中纳入的 PKG 证据基于一项临床试验的结果。健康状态效用进行了映射，并且从 bootstrap 方法得出了患者从未控制状态向控制状态进展的概率，该方法假设 MDS-UPDRS 的分布为正态分布。

结果

将 PKG 添加到常规 PD 评估中是一种具有成本效益的干预措施。与常规评估相比（£141,950 对 £159,312），PKG 加常规评估与较低的总成本相关，并且改善了质量调整生命年（7.88 对 7.61），导致增量成本效益比为 -£64,978.99，使用 £20,000 阈值的净货币收益为 £22,706.37。结果在敏感性和情景分析中具有稳健性。