标准化临床营养诊断与治疗路径在肺部感染患者中的成本效果分析。
Cost-Effectiveness Analysis of Standardized Clinical Nutrition Diagnosis and Treatment Pathway in Patients with Pulmonary Infection.
机构信息
Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan, China.
出版信息
Comput Math Methods Med. 2022 Jul 26;2022:6706390. doi: 10.1155/2022/6706390. eCollection 2022.
OBJECTIVE
From the perspective of economics, this study discusses the value of establishing a standardized clinical nutrition diagnosis and treatment pathway in the diagnosis and treatment of pulmonary infection and provides a reference for optimizing the diagnosis and treatment pathway of pulmonary infection.
METHODS
The patients who received the nutrition diagnosis and treatment pathway intervention in 2017 were counted as the routine group and were subdivided into the conventional intervention group (C1) and conventional control group (C2) according to whether the standardized nutrition therapy was applied or not. The patients who received the nutrition diagnosis and treatment pathway intervention in 2020 were counted as the experimental group and were subdivided into the experimental intervention group (T1) and the experimental control group (T2) according to whether standardized intervention was applied or not. The total hospitalization expenses, average daily hospitalization cost, nutrition support expenses, plasma albumin before and after nutrition support, readmission, and other indicators of all patients were recorded and compared. The cost-effectiveness ratio (CER), incremental cost-effectiveness ratio (ICER), and cost-effectiveness threshold for cost-effectiveness analysis were adopted.
RESULTS
Compared with the C2 group, the C1 group had higher total hospitalization expenses, average daily hospitalization expenses, nutritional support expenses, and plasma albumin improvement rate and lower readmission rate ( < 0.001). Compared with the T2 group, the T1 group had higher total hospitalization cost, average daily hospitalization expenses, nutritional support expenses, and plasma albumin improvement rate and lower readmission rate ( < 0.001). Taking the improvement rate of plasma albumin as the effect index, compared with the C1 group, the T1 group has less investment cost and better effect, and the ICER is negative (below the cost-effect threshold). And taking the readmission rate as the effective index, compared with the C1 group, the T1 group invested less cost and had a better effect, and the ICER was negative (below the cost-effect threshold).
CONCLUSION
For the patients with pulmonary infection, whether the improvement rate of plasma albumin or the readmission rate is used as the impact index, the standardized nutrition diagnosis and treatment pathway in 2020 is more economical than the nonstandardized nutrition diagnosis and treatment pathway.
目的
从经济学角度探讨建立规范化临床营养诊疗路径在肺部感染诊治中的价值，为优化肺部感染的诊疗路径提供参考。
方法
将 2017 年接受营养诊疗路径干预的患者作为常规组，根据是否应用规范化营养治疗分为常规干预组（C1 组）和常规对照组（C2 组）。将 2020 年接受营养诊疗路径干预的患者作为实验组，根据是否应用规范化干预分为实验干预组（T1 组）和实验对照组（T2 组）。记录并比较所有患者的总住院费用、平均日住院费用、营养支持费用、营养支持前后血浆白蛋白、再入院等指标。采用成本效果分析的成本效益比（CER）、增量成本效果比（ICER）和成本效果阈值。
结果
与 C2 组比较，C1 组总住院费用、平均日住院费用、营养支持费用、血浆白蛋白改善率更高，再入院率更低（<0.001）。与 T2 组比较，T1 组总住院费用、平均日住院费用、营养支持费用、血浆白蛋白改善率更高，再入院率更低（<0.001）。以血浆白蛋白改善率为效果指标，与 C1 组比较，T1 组投入成本更少，效果更好，ICER 为负值（低于成本效果阈值）。以再入院率为效果指标，与 C1 组比较，T1 组投入成本更少，效果更好，ICER 为负值（低于成本效果阈值）。
结论
对于肺部感染患者，无论是以血浆白蛋白改善率还是再入院率作为影响指标，2020 年规范化营养诊疗路径都比非规范化营养诊疗路径更经济。
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