Department of Healthcare Administration and Healthcare Policy, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA.
Center for Health Disparities Research, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA.
Int J Environ Res Public Health. 2024 Oct 18;21(10):1381. doi: 10.3390/ijerph21101381.
To people living with Alzheimer's Disease-Related Disorders (ADRD), timely and coordinated communication is essential between their informal caregivers and healthcare providers. In provider shortage areas, for example, the state of Nevada, telehealth can be an effective primary care delivery alternative to in-person visits. To evaluate the cost-effectiveness of telehealth visits for people living with ADRD in the state of Nevada, a decision-analytic Markov model was developed from healthcare system perspectives with a 10-year horizon/1-year cycle. To estimate the effects of demographic and geographic parameters on the Markov model, race parameters were divided into non-Hispanic White individuals vs. others and location parameters were divided into urban vs. rural. A 12-item short-version Zarit Burden Interview (ZBI-12) was applied to measure the informal caregiver burdens of non-institutionalized people living with ADRD. The values of mortality rate and healthcare utilization were obtained from healthcare systems' publicly available payor administrative data and Nevada State Inpatient/Emergency Department datasets. Among urban-residing non-Hispanic White individuals, the Incremental Cost-Effectiveness Ratio (ICER) per modified ZBI-12 indicated a cost saving of USD 9.44 with telehealth visits; among urban-residing racial minorities, the ICER per modified ZBI-12 indicated a cost saving of USD 29.26 with in-person visits; and among rural residents, the ICER per modified ZBI-12 indicated a cost-saving of USD 320.93 with telehealth visits. Distributional differences in the cost-saving effects of telehealth primary care were noted in line with racial and geographic parameters. Workforce and caregiver training is necessary for reducing distributional differences, especially among urban-residing racial monitories living with ADRD in the provider shortage area of the state of Nevada.
对于患有阿尔茨海默病相关障碍（ADRD）的人来说，其非正式照顾者和医疗保健提供者之间进行及时和协调的沟通至关重要。例如，在医疗资源短缺的内华达州，远程医疗可以作为一种有效的替代面对面就诊的初级保健服务模式。为了评估远程医疗就诊对该州患有 ADRD 人群的成本效益，从医疗保健系统的角度出发，开发了一个具有 10 年时间范围/1 年周期的决策分析马尔可夫模型。为了估计人口统计学和地理位置参数对马尔可夫模型的影响，种族参数分为非西班牙裔白人个体与其他人，地理位置参数分为城市与农村。采用 12 项简短 Zarit 负担量表（ZBI-12）来衡量非住院 ADRD 患者的非正式照顾者负担。死亡率和医疗保健利用率的值是从医疗保健系统公开的支付方行政数据和内华达州住院/急诊数据集获得的。在城市居住的非西班牙裔白人群体中，每例经修正的 ZBI-12 增量成本效益比（ICER）表明，远程医疗就诊可节省 9.44 美元；在城市居住的少数民族中，每例经修正的 ZBI-12 增量成本效益比（ICER）表明，面对面就诊可节省 29.26 美元；在农村居民中，每例经修正的 ZBI-12 增量成本效益比（ICER）表明，远程医疗就诊可节省 320.93 美元。根据种族和地理位置参数，远程医疗初级保健的成本节约效果存在分布差异。需要进行劳动力和照顾者培训，以减少分布差异，尤其是在医疗资源短缺的内华达州，城市居住的少数民族人群中患有 ADRD 的患者。
