Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK.
Value Health. 2022 Oct;25(10):1717-1725. doi: 10.1016/j.jval.2022.04.1728. Epub 2022 May 25.
This study aimed to investigate how multicriteria decision analysis (MCDA) could complement cost-effectiveness analysis (CEA) to support investment decisions in elderly care at local level.
We used an integrated elderly care program in The Netherlands as a case study to demonstrate the application of both methods. In a 12-month quasi-experimental study (n = 384), data on the following outcome measures were collected: quality-adjusted life-years (CEA) and physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person centeredness, continuity of care, and costs (MCDA). We performed regression analysis on inversed probability weighted data and controlled for potential confounders to obtain a double robust estimate of the outcomes. Probabilistic sensitivity analyses determined uncertainty for both methods.
The integrated elderly care program was not likely (ie, 36%) to be cost-effective according to the CEA (incremental cost-effectiveness ratios: €88 249 from a societal perspective) using the conventional Dutch willingness-to-pay threshold (ie, €50 000). The MCDA demonstrated that informal caregivers and professionals slightly preferred the intervention over usual care, driven by enjoyment of life and person centeredness. Patients did not prefer either the intervention or usual care, whereas payers and policy makers slightly preferred usual care, mainly due to higher costs of the intervention.
MCDA could provide local-level decision makers with a broader measurement of effectiveness by including outcomes beyond health and longevity and the preferences of multiple stakeholders. This additional information could foster the acceptability and implementability of cost-effective innovations in elderly care.
本研究旨在探讨多准则决策分析（MCDA）如何补充成本效益分析（CEA），以支持地方层面的老年护理投资决策。
我们使用荷兰的一个综合老年护理计划作为案例研究，展示两种方法的应用。在一项为期 12 个月的准实验研究（n=384）中，收集了以下结果测量数据：质量调整生命年（CEA）和身体功能、心理幸福感、社会关系和参与、生活享受、韧性、以人为主、护理连续性和成本（MCDA）。我们对逆概率加权数据进行回归分析，并控制潜在混杂因素，以获得结果的双重稳健估计。概率敏感性分析确定了两种方法的不确定性。
根据 CEA（社会视角下的增量成本效益比：€88249），使用传统的荷兰意愿支付阈值（即€50000），综合老年护理计划不太可能（即 36%）具有成本效益。MCDA 表明，非正式照顾者和专业人员略微更喜欢干预措施而不是常规护理，这主要是因为生活享受和以人为本的特点。患者既不喜欢干预措施，也不喜欢常规护理，而支付者和政策制定者则稍微更喜欢常规护理，主要是因为干预措施的成本更高。
MCDA 可以通过纳入健康和寿命以外的结果以及多个利益相关者的偏好，为地方层面的决策者提供更广泛的有效性衡量标准。这些额外的信息可以促进老年护理中具有成本效益的创新的可接受性和实施性。
