德国冠心病患者身体活动激励措施的成本效益：遵循新医学研究委员会框架的复杂干预措施的预试验健康经济模型

Cost-effectiveness of incentives for physical activity in coronary heart disease in Germany: pre-trial health economic model of a complex intervention following the new MRC framework.

作者信息

Mohebbi Damon, Ogurtsova Katherine, Dyczmons Jan, Dintsios Markos, Kairies-Schwarz Nadja, Jung Christian, Icks Andrea

机构信息

Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

出版信息

BMJ Open Sport Exerc Med. 2024 May 27;10(2):e001896. doi: 10.1136/bmjsem-2024-001896. eCollection 2024.

DOI:10.1136/bmjsem-2024-001896

PMID:38808264

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11131112/

Abstract

OBJECTIVES

The German Incentives for Physical Activity in Cardiac Patients trial is a three-arm, randomised controlled trial for secondary prevention of coronary heart disease (CHD). Guidance for developing complex interventions recommends pre-trial health economic modelling. The aim of this study is to model the long-term cost-effectiveness of the incentive-based physical activity interventions in a population with CHD.

METHODS

A decision-analytical Markov model was developed from a health services provider perspective, following a cohort aged 65 years with a previous myocardial infarction for 25 years. Monetary and social incentives were compared relative to no incentive. Intervention effects associated with physical activity were used to determine the costs, quality-adjusted life-years (QALYs) gained, incremental cost-effectiveness and cost-utility ratios. The probability of cost-effectiveness was calculated through sensitivity analyses.

RESULTS

The incremental QALYs gained from the monetary and social incentives, relative to control, were respectively estimated at 0.01 (95% CI 0.00 to 0.01) and 0.04 (95% CI 0.02 to 0.05). Implementation of the monetary and social incentive interventions increased the costs by €874 (95% CI €744 to €1047) and €909 (95% CI €537 to €1625). Incremental cost-utility ratios were €25 912 (95% CI €15 056 to €50 210) and €118 958 (95% CI €82 930 to €196 121) per QALY gained for the social and monetary incentive intervention, respectively. With a willingness-to-pay threshold set at €43 000/QALY, equivalent to the per-capita gross domestic product in Germany, the probability that the social and monetary incentive intervention would be seen as cost-effective was 95% and 0%, respectively.

CONCLUSIONS

Exercise-based secondary prevention using inventive schemes may offer a cost-effective strategy to reduce the burden of CHD.

摘要

目的

德国心脏病患者体育活动激励试验是一项针对冠心病（CHD）二级预防的三臂随机对照试验。制定复杂干预措施的指南建议进行试验前健康经济建模。本研究的目的是对冠心病患者群体中基于激励的体育活动干预措施的长期成本效益进行建模。

方法

从卫生服务提供者的角度开发了一个决策分析马尔可夫模型，跟踪一组65岁且曾发生过心肌梗死的人群25年。将金钱激励和社会激励与无激励进行比较。与体育活动相关的干预效果用于确定成本、获得的质量调整生命年（QALY）、增量成本效益和成本效用比。通过敏感性分析计算成本效益的概率。

结果

相对于对照组，金钱激励和社会激励获得的增量QALY分别估计为0.01（95%CI 0.00至0.01）和0.04（95%CI 0.02至0.05）。实施金钱激励和社会激励干预措施使成本分别增加了874欧元（95%CI 744欧元至1047欧元）和909欧元（95%CI 537欧元至1625欧元）。社会激励和金钱激励干预措施每获得一个QALY的增量成本效用比分别为25912欧元（95%CI 15056欧元至50210欧元）和118958欧元（95%CI 82930欧元至196121欧元）。将支付意愿阈值设定为43000欧元/QALY（相当于德国人均国内生产总值），社会激励和金钱激励干预措施被视为具有成本效益的概率分别为95%和0%。