Yan Charles, Round Jeff, Akpinar Ilke, Atwood Chantal E, Deuchar Lesly, Bhutani Mohit, Leigh Richard, Stickland Michael K
Institute of Health Economics, 10405 Jasper Avenue, Edmonton, AB, T5J 3N4, Canada.
Institute of Health Economics, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Pharmacoecon Open. 2023 May;7(3):493-505. doi: 10.1007/s41669-023-00400-7. Epub 2023 Mar 11.
Appropriate management of chronic obstructive pulmonary disease (COPD) patients following acute exacerbations can reduce the risk of future exacerbations, improve health status, and lower care costs. While a transition care bundle (TCB) was associated with lower readmissions to hospitals than usual care (UC), it remains unclear whether the TCB was associated with cost savings.
The aim of this study was to evaluate how this TCB was associated with future Emergency Department (ED)/outpatient visits, hospital readmissions, and costs in Alberta, Canada.
Patients who were aged 35 years or older, who were admitted to hospital for a COPD exacerbation, and had not been treated with a care bundle received either TCB or UC. Those who received the TCB were then randomized to either TCB alone or TCB enhanced with a care coordinator. Data collected were ED/outpatient visits, hospital admissions and associated resources used for index admissions, and 7-, 30- and 90-day post-index discharge. A decision model with a 90-day time horizon was developed to estimate the cost. A generalized linear regression was conducted to adjust for imbalance in patient characteristics and comorbidities, and a sensitivity analysis was conducted on the proportion of patients' combined ED/outpatient visits and inpatient admissions as well as the use of a care coordinator.
Differences in length of stay (LOS) and costs between groups were statistically significant, although with some exceptions. Inpatient LOS and costs were 7.1 days (95% confidence interval [CI] 6.9-7.3) and Canadian dollars (CAN$) 13,131 (95% CI CAN$12,969-CAN$13,294) in UC, 6.1 days (95% CI 5.8-6.5) and CAN$7634 (95% CI CAN$7546-CAN$7722) in TCB with a coordinator, and 5.9 days (95% CI 5.6-6.2) and CAN$8080 (95% CI CAN$7975-CAN$8184) in TCB without a coordinator. Decision modelling indicated TCB was less costly than UC, with a mean (standard deviation [SD]) of CAN$10,172 (40) versus CAN$15,588 (85), and TCB with a coordinator was slightly less costly than without a coordinator (CAN$10,109 [49] versus CAN$10,244 [57]).
This study suggests that the use of the TCB, with or without a care coordinator, appears to be an economically attractive intervention compared with UC.
对慢性阻塞性肺疾病（COPD）急性加重后的患者进行恰当管理，可降低未来急性加重的风险，改善健康状况，并降低护理成本。虽然过渡护理套餐（TCB）与低于常规护理（UC）的医院再入院率相关，但TCB是否能节省成本仍不明确。
本研究的目的是评估该TCB与加拿大艾伯塔省患者未来的急诊科（ED）/门诊就诊、医院再入院及成本之间的关联。
年龄在35岁及以上、因COPD急性加重入院且未接受过护理套餐治疗的患者，接受了TCB或UC。接受TCB的患者随后被随机分为单独接受TCB或在护理协调员协助下强化的TCB。收集的数据包括ED/门诊就诊、医院入院情况以及用于首次入院的相关资源，还有首次出院后7天、30天和90天的情况。开发了一个90天时间跨度的决策模型来估算成本。进行广义线性回归以调整患者特征和合并症的不平衡，并对患者ED/门诊就诊与住院入院合并比例以及护理协调员的使用情况进行敏感性分析。
尽管存在一些例外情况，但两组之间的住院时长（LOS）和成本差异具有统计学意义。常规护理组的住院LOS和成本分别为7.1天（95%置信区间[CI] 6.9 - 7.3）和13,131加元（95% CI 12,969加元 - 13,294加元）；有护理协调员的TCB组为6.1天（95% CI 5.8 - 6.5）和7634加元（95% CI 7546加元 - 7722加元）；无护理协调员的TCB组为5.9天（95% CI 5.6 - 6.2）和8080加元（95% CI 7975加元 - 8184加元）。决策模型表明，TCB比UC成本更低，均值（标准差[SD]）分别为10,172加元（40）和15,588加元（85），且有护理协调员的TCB比无护理协调员的TCB成本略低（10,109加元[49]对10,244加元[57]）。
本研究表明，与常规护理相比，无论有无护理协调员，使用TCB似乎都是一种在经济上有吸引力的干预措施。
