Ulfsdottir Hildigunnur, Bäck Maria, Cider Åsa, Jivegård Lennart, Sandberg Anna, Nordanstig Joakim, Svensson Mikael
School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.
Sidekick Health, 413 90 Gothenburg, Sweden.
J Clin Med. 2023 Aug 14;12(16):5277. doi: 10.3390/jcm12165277.
Hospital-based supervised exercise (SEP) is a guideline-recommended intervention for patients with intermittent claudication (IC). However, due to the limited availability of SEP, home-based structured exercise programs (HSEP) have become increasingly popular alongside the "go home and walk" advice. We evaluated the cost-effectiveness of walk advice (WA) with Nordic pole walking vs. SEP combined with WA or HSEP combined with WA. We used data from the SUNFIT RCT (NCT02341716) to measure quality-adjusted life-years (QALYs) over a 12-month follow-up, and economic costs were obtained from a hospital cost-per-patient accounting system. Incremental cost-effectiveness ratios (ICERs) were calculated, and uncertainty was assessed using nonparametric bootstrapping. The average health-care-cost per patient was similar in the WA (EUR 1781, n = 51) and HSEP (EUR 1820, n = 48) groups but higher in the SEP group (EUR 4619, n = 50, -value < 0.01). Mean QALYs per patient during the follow-up were similar with no statistically significant differences. The findings do not support SEP as a cost-effective treatment for IC, as it incurred significantly higher costs without providing additional health improvements over WA with or without HSEP during the one-year observation period. The analysis also suggested that HSEP may be cost-effective compared to WA, but only with a 64% probability.
基于医院的监督性运动（SEP）是间歇性跛行（IC）患者指南推荐的干预措施。然而，由于SEP的可及性有限，居家结构化运动计划（HSEP）与“回家步行”建议一起越来越受欢迎。我们评估了北欧式健走步行建议（WA）与SEP联合WA或HSEP联合WA的成本效益。我们使用SUNFIT随机对照试验（NCT02341716）的数据来测量12个月随访期间的质量调整生命年（QALY），经济成本从医院每位患者的成本核算系统中获取。计算增量成本效益比（ICER），并使用非参数自助法评估不确定性。WA组（1781欧元，n = 51）和HSEP组（1820欧元，n = 48）每位患者的平均医疗保健成本相似，但SEP组（4619欧元，n = 50，P值<0.01）更高。随访期间每位患者的平均QALY相似，无统计学显著差异。研究结果不支持SEP作为IC的成本效益治疗方法，因为在一年观察期内，与有或没有HSEP的WA相比，SEP产生的成本显著更高，且未带来额外的健康改善。分析还表明，与WA相比，HSEP可能具有成本效益，但概率仅为64%。
