Huang Wei, Wang Yuqiang, Luo Zeruxin, Zhang Xiu, Yang Mengxuan, Su Jianhua, Guo Yingqiang, Yu Pengming
Department of Rehabilitation Medicine, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
Department of Cardiac Surgery, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
Rev Cardiovasc Med. 2024 Sep 10;25(9):323. doi: 10.31083/j.rcm2509323. eCollection 2024 Sep.
While prehabilitation (pre surgical exercise) effectively prevents postoperative pulmonary complications (PPCs), its cost-effectiveness in valve heart disease (VHD) remains unexplored. This study aims to evaluate the cost-effectiveness of a three-day prehabilitation program for reducing PPCs and improving quality adjusted life years (QALYs) in Chinese VHD patients.
A cost-effectiveness analysis was conducted alongside a randomized controlled trial featuring concealed allocation, blinded evaluators, and an intention-to-treat analysis. In total, 165 patients scheduled for elective heart valve surgery at West China Hospital were randomized into intervention and control groups. The intervention group participated in a three-day prehabilitation exercise program supervised by a physiotherapist while the control group received only standard preoperative education. Postoperative hospital costs were audited through the Hospital Information System, and the EuroQol five-dimensional questionnaire was used to provide a 12-month estimation of QALY. Cost and effect differences were calculated through the bootstrapping method, with results presented in cost-effectiveness planes, alongside the associated cost-effectiveness acceptability curve (CEAC). All costs were denominated in Chinese Yuan (CNY) at an average exchange rate of 6.73 CNY per US dollar in 2022.
There were no statistically significant differences in postoperative hospital costs (8484 versus 9615 CNY, 95% CI -2403 to 140) or in the estimated QALYs (0.909 versus 0.898, 95% CI -0.013 to 0.034) between the intervention and control groups. However, costs for antibiotics (339 versus 667 CNY, 95% CI -605 to -51), nursing (1021 versus 1200 CNY, 95% CI -330 to -28), and electrocardiograph monitoring (685 versus 929 CNY, 95% CI -421 to -67) were significantly lower in the intervention group than in the control group. The CEAC indicated that the prehabilitation program has a 92.6% and 93% probability of being cost-effective in preventing PPCs and improving QALYs without incurring additional costs.
While the three-day prehabilitation program did not significantly improve health-related quality of life, it led to a reduction in postoperative hospital resource utilization. Furthermore, it showed a high probability of being cost-effective in both preventing PPCs and improving QALYs in Chinese patients undergoing valve surgery.
This trial is registered in the Chinese Clinical Trial Registry (URL: https://www.chictr.org.cn/) with the registration identifier ChiCTR2000039671.
虽然术前康复（手术前运动）能有效预防术后肺部并发症（PPCs），但其在心脏瓣膜病（VHD）中的成本效益仍未得到探索。本研究旨在评估一项为期三天的术前康复计划在中国VHD患者中降低PPCs及改善质量调整生命年（QALYs）的成本效益。
在一项采用隐藏分配、盲法评估和意向性分析的随机对照试验的同时进行成本效益分析。共有165名计划在华西医院接受择期心脏瓣膜手术的患者被随机分为干预组和对照组。干预组参加了由物理治疗师监督的为期三天的术前康复运动计划，而对照组仅接受标准的术前教育。通过医院信息系统审核术后住院费用，并使用欧洲五维健康量表问卷对QALY进行12个月的评估。通过自抽样法计算成本和效果差异，结果以成本效益平面以及相关的成本效益可接受性曲线（CEAC）呈现。所有成本均以人民币（CNY）计价，2022年平均汇率为1美元兑6.73元人民币。
干预组和对照组在术后住院费用（8484元对9615元，95%CI -2403至140）或估计的QALYs（0.909对0.898，95%CI -0.013至0.034）方面无统计学显著差异。然而，干预组的抗生素费用（339元对667元，95%CI -605至-51）、护理费用（1021元对1200元，95%CI -330至-28）和心电图监测费用（685元对929元，95%CI -421至-67）显著低于对照组。CEAC表明，术前康复计划在预防PPCs和改善QALYs且不产生额外成本方面具有成本效益的概率分别为92.6%和93% .
虽然为期三天的术前康复计划并未显著改善健康相关生活质量，但它导致术后医院资源利用减少。此外，在中国接受瓣膜手术的患者中，该计划在预防PPCs和改善QALYs方面均显示出具有成本效益的高概率。
本试验在中国临床试验注册中心（网址：https://www.chictr.org.cn/）注册，注册号为ChiCTR2000039671。
