Xu Lizheng, Yang Minghui, Zhang Xinyi, Zhang Jing, He Jiusheng, Wen Liangyuan, Wang Xianhai, Shi Zongxin, Hu Sanbao, Sun Fengpo, Gong Zishun, Sun Mingyao, Peng Ke, Ye Pengpeng, Ma Ruofei, Wu Xinbao, Chen Mingsheng, Jan Stephen, Ivers Rebecca, Tian Maoyi, Si Lei
The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Lancet Reg Health West Pac. 2024 Jul 22;49:101149. doi: 10.1016/j.lanwpc.2024.101149. eCollection 2024 Aug.
The clinical effectiveness of multidisciplinary co-managed care for hip fracture patients in China has been demonstrated in a multicenter non-randomized controlled study. This study aims to estimate the cost-effectiveness of the co-managed care.
The study is based on a multicenter clinical trial (n = 2071) in China. We developed a state transition microsimulation model to estimate the cost-effectiveness of the co-managed care compared with usual care for hip fracture patients from healthcare system perspective. The costs incorporated into the model included hospitalization costs, post-discharge expenses, and secondary fracture therapy costs. Effectiveness was measured using quality-adjusted life years (QALYs). Costs and effects were discounted at 5% annually. A simulation cycle length of 1-year and a lifetime horizon were employed. The cost-effectiveness threshold was established at USD 37,118. To address uncertainties, one-way deterministic sensitivity analysis and probabilistic sensitivity analysis were conducted.
In the base case analysis, the co-managed care group had a lifetime cost of USD 31,571 and achieved an effectiveness of 3.22 QALYs, whereas the usual care group incurred a cost of USD 27,878 and gained 2.85 QALYs. The incremental cost-effectiveness ratio was USD 9981 per QALY gained; thus the co-managed care model was cost-effective. The cost-effectiveness was sensitive to the age of having hip fractures and hospitalization costs in the intervention group.
The co-managed care in hip fracture patients represents value for money, and should be scaled up and prioritized for funding in China.
The study is supported by Capital's Funds for Health Improvement and Research (2022-1-2071, 2018-1-2071).
在中国进行的一项多中心非随机对照研究已证明多学科联合管理护理对髋部骨折患者的临床有效性。本研究旨在评估联合管理护理的成本效益。
该研究基于中国的一项多中心临床试验（n = 2071）。我们开发了一个状态转换微观模拟模型，从医疗保健系统的角度评估联合管理护理与髋部骨折患者常规护理相比的成本效益。纳入模型的成本包括住院费用、出院后费用和二次骨折治疗费用。使用质量调整生命年（QALYs）来衡量有效性。成本和效果按每年5%进行贴现。采用1年的模拟周期长度和终身时间范围。成本效益阈值设定为37,118美元。为解决不确定性问题，进行了单向确定性敏感性分析和概率敏感性分析。
在基础案例分析中，联合管理护理组的终身成本为31,571美元，有效性为3.22个QALYs，而常规护理组的成本为27,878美元，获得2.85个QALYs。每获得一个QALY的增量成本效益比为9981美元；因此，联合管理护理模式具有成本效益。成本效益对髋部骨折患者的年龄和干预组的住院费用敏感。
髋部骨折患者的联合管理护理具有性价比，在中国应扩大规模并优先获得资金支持。
本研究由首都健康改善与研究基金（2022 - 1 - 2071，2018 - 1 - 2071）资助。
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