新冠肺炎后住院成人的 COVID-19 后(post-COVID-19)状况的线上监督团体身心康复计划的成本效益：REGAIN RCT 研究。

Cost-effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-COVID-19 condition after hospitalisation for COVID-19: the REGAIN RCT.

机构信息

Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.

University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.

出版信息

BMC Health Serv Res. 2024 Oct 31;24(1):1326. doi: 10.1186/s12913-024-11679-5.

DOI:10.1186/s12913-024-11679-5

PMID:39482691

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11528998/

Abstract

BACKGROUND

Following the COVID-19 pandemic, millions of people continue to experience ongoing physical and mental health sequelae after recovery from acute infection. There is currently no specific treatment for the diverse symptoms associated with post-COVID-19 condition. Physical and mental health rehabilitation may help improve quality of life in such patients. This study reports the cost-effectiveness of a programme of physical and mental health rehabilitation compared to best practice usual care in people with post-COVID-19 condition who were previously hospitalised.

METHODS

We conducted an economic evaluation within a randomised controlled trial from the perspective of the UK national health service (NHS) and personnel social services perspective (PSS). Resource used and health-related quality of life were collected using bespoke questionnaire and the EQ-5D-5 L questionnaire at three, six, and 12 months. Incremental costs and quality adjusted life years accrued over the follow-up period were estimated and reported as the incremental cost-effectiveness ratio. Estimate uncertainty was managed by multiple imputation and bootstrapping cost-effectiveness estimates; and displayed graphically on the cost-effectiveness plane.

RESULTS

Over a 12-month time horizon, incremental costs and QALYs were £305 (95% CI: -123 to 732) and 0.026 (95% CI: -0.005 to 0.052) respectively. The ICER was £11,941 per QALY indicating cost-effective care. Sensitivity analyses supported the base case findings. The probability of the intervention being cost-effective at a £30,000 per QALY willingness-to-pay threshold was 84%.

CONCLUSION

The within-trial economic evaluation suggested that people with post-COVID-19 condition after hospitalisation should be offered a programme of physical and mental health rehabilitation as it likely reflects a cost-effective use of NHS resources. Hospitalisation for COVID-19 has become less commonplace: further evaluation in non-hospitalised patients may be worthwhile.

TRIAL REGISTRATION

ISRCTN registry ISRCTN11466448 23rd November 2020.

摘要

背景

在 COVID-19 大流行之后，数以百万计的人在急性感染康复后仍持续出现身体和心理健康后遗症。目前，针对与 COVID-19 后状况相关的各种症状，还没有特定的治疗方法。身体和心理健康康复可能有助于改善此类患者的生活质量。本研究报告了与 COVID-19 后状况患者的最佳常规护理相比，对以前住院的 COVID-19 后状况患者进行身体和心理健康康复计划的成本效益。

方法

我们在一项随机对照试验中进行了经济评估，从英国国家医疗服务体系（NHS）和人员社会服务视角（PSS）的角度出发。使用专门的问卷和 EQ-5D-5L 问卷在 3、6 和 12 个月时收集资源使用情况和与健康相关的生活质量数据。估计并报告了在随访期间产生的增量成本和调整后的生命年数，并将其表示为增量成本效益比。通过多重插补和引导成本效益估计来管理估计的不确定性，并在成本效益平面上进行图形显示。

结果

在 12 个月的时间内，增量成本和 QALY 分别为 305 英镑（95%CI：-123 至 732）和 0.026（95%CI：-0.005 至 0.052）。ICER 为每 QALY 11941 英镑，表明护理具有成本效益。敏感性分析支持了基础案例的结果。在 30000 英镑/QALY 的意愿支付阈值下，该干预措施具有成本效益的概率为 84%。