STRIDE研究中跌倒损伤的成本：医疗保健系统异质性和治疗效果异质性的经济评估

Costs of fall injuries in the STRIDE study: an economic evaluation of healthcare system heterogeneity and heterogeneity of treatment effect.

作者信息

Ganz David A, Gill Thomas M, Reuben David B, Bhasin Shalender, Latham Nancy K, Peduzzi Peter, Greene Erich J

机构信息

Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

出版信息

Cost Eff Resour Alloc. 2023 Aug 2;21(1):49. doi: 10.1186/s12962-023-00459-3.

DOI:10.1186/s12962-023-00459-3

PMID:37533073

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10399038/

Abstract

OBJECTIVES

The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) Study cluster-randomized 86 primary care practices in 10 healthcare systems to a patient-centered multifactorial fall injury prevention intervention or enhanced usual care, enrolling 5451 participants. We estimated total healthcare costs from participant-reported fall injuries receiving medical attention (FIMA) that were averted by the STRIDE intervention and tested for healthcare-system-level heterogeneity and heterogeneity of treatment effect (HTE).

METHODS

Participants were community-dwelling adults age ≥ 70 at increased fall injury risk. We estimated practice-level total costs per person-year of follow-up (PYF), assigning unit costs to FIMA with and without an overnight hospital stay. Using independent variables for treatment arm, healthcare system, and their interaction, we fit a generalized linear model with log link, log follow-up time offset, and Tweedie error distribution.

RESULTS

Unadjusted total costs per PYF were $2,034 (intervention) and $2,289 (control). The adjusted (intervention minus control) cost difference per PYF was -$167 (95% confidence interval (CI), -$491, $216). Cost heterogeneity by healthcare system was present (p = 0.035), as well as HTE (p = 0.090). Adjusted total costs per PYF in control practices varied from $1,529 to $3,684 for individual healthcare systems; one system with mean intervention minus control costs of -$2092 (95% CI, -$3,686 to -$944) per PYF accounted for HTE, but not healthcare system cost heterogeneity.

CONCLUSIONS

We observed substantial heterogeneity of healthcare system costs in the STRIDE study, with small reductions in healthcare costs for FIMA in the STRIDE intervention accounted for by a single healthcare system.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT02475850).

摘要

目的

“减少老年人伤害并增强其信心策略（STRIDE）”研究将10个医疗系统中的86个初级保健机构整群随机分为以患者为中心的多因素跌倒伤害预防干预组或强化常规治疗组，共纳入5451名参与者。我们估算了STRIDE干预避免的因参与者报告并接受医疗关注的跌倒伤害（FIMA）产生的总医疗费用，并检验了医疗系统层面的异质性和治疗效果异质性（HTE）。

方法

参与者为社区居住的、跌倒伤害风险增加的70岁及以上成年人。我们估算了每个随访人年（PYF）的机构层面总费用，为有或无过夜住院治疗的FIMA分配单位费用。使用治疗组、医疗系统及其交互作用的自变量，我们拟合了一个具有对数链接、对数随访时间偏移和Tweedie误差分布的广义线性模型。

结果

未经调整的每个PYF总费用为干预组2034美元，对照组2289美元。调整后的（干预组减去对照组）每个PYF费用差值为 -167美元（95%置信区间（CI），-491美元，216美元）。存在医疗系统导致的费用异质性（p = 0.035）以及HTE（p = 0.090）。对照组机构中，每个PYF的调整后总费用在各个医疗系统中从1529美元到3684美元不等；一个医疗系统的平均干预组减去对照组费用为每个PYF -2092美元（95%CI，-3686美元至-944美元），该系统解释了HTE，但未解释医疗系统费用异质性。