低疾病活动度 RA 患者自我监测联合患者启动的治疗：一项 RCT 的成本效益分析。

Self-monitoring combined with patient-initiated care in RA patients with low disease activity: cost-effectiveness analysis of an RCT.

机构信息

Amsterdam Rheumatology and Immunology Center, Reade Rheumatology and Rehabilitation, Amsterdam, The Netherlands.

Department of Rheumatology and Immunology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands.

出版信息

Rheumatology (Oxford). 2023 Oct 3;62(10):3366-3372. doi: 10.1093/rheumatology/kead084.

DOI:10.1093/rheumatology/kead084

PMID:36799560

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10547523/

Abstract

OBJECTIVES

Self-monitoring and patient-initiated care (PIC) leads to fewer outpatient clinic visits in patients with established RA with low disease activity (LDA) while healthcare outcomes are similar. This study assesses the cost-effectiveness of PIC with self-monitoring.

METHODS

A 12-month randomized controlled trial was performed with 49 patients in the PIC with self-monitoring group (app-group) and 53 in usual care. The usual care group continued with preplanned visits. The app group had one planned follow-up visit after 12 months and monitored their RA disease activity in a smartphone app. Both groups could make additional appointments at liberty. We included adult RA patients with a disease duration of over 2 years, a disease activity score 28 (DAS28) below 3.2 that were stable on medication for at least 6 months. The effect measure, the DAS28, was measured at 12 months and healthcare resource usage and productivity losses were measured at 3, 6, 9 and 12 months.

RESULTS

There was no significant difference in mean change of DAS28 (-0.04 mean difference, 95% CI: -0.39, 0.30), nor a statistically significant difference in total costs (mean difference €514, 95% CI:-€266, €3690) in the app group compared with the usual care group. The probability that the app was cost-effective was 0.37 and 0.57 at a willingness-to-pay threshold of 0 and 50 000 €/point improvement DAS28, respectively.

CONCLUSION

Although rheumatic care costs were significantly lower in the app group, total costs and effects of PIC with self-monitoring were not different from usual care in RA patients with LDA.

摘要

目的

在疾病活动度低（LDA）的已确诊类风湿关节炎（RA）患者中，自我监测和患者发起的护理（PIC）可减少门诊就诊次数，同时保持相似的医疗保健效果。本研究评估了自我监测的 PIC 的成本效益。

方法

进行了一项为期 12 个月的随机对照试验，共有 49 名患者被分配到自我监测组（应用程序组），53 名患者被分配到常规护理组。常规护理组继续按计划进行就诊。应用程序组在 12 个月后进行一次计划随访，并在智能手机应用程序中监测他们的 RA 疾病活动度。两组都可以自由预约额外的就诊。我们纳入了疾病持续时间超过 2 年、疾病活动评分 28（DAS28）低于 3.2、且至少 6 个月稳定用药的成年 RA 患者。在 12 个月时测量效果指标 DAS28，在 3、6、9 和 12 个月时测量医疗资源使用情况和生产力损失。

结果

应用程序组与常规护理组相比，DAS28 的平均变化无显著差异（平均差异 0.04，95%CI：-0.39，0.30），总费用也无统计学差异（平均差异 514 欧元，95%CI：-266 欧元，3690 欧元）。在愿意支付 0 欧元和 50000 欧元/DAS28 改善点的阈值下，应用程序具有成本效益的概率分别为 0.37 和 0.57。