Pelletier-Fleury N, Lanoë J L, Fleury B, Fardeau M
Centre de Recherches en Economie de la Santé, INSERM U357, Hôpital de Kremlin-Bicêtre.
Rev Epidemiol Sante Publique. 1997 Mar;45(1):53-63.
In France, home oxygen therapy for patients with chronic obstructive pulmonary disease (COPD) is carried out by nonprofit associations (NP) or profit-making health organisations (PM). In a retrospective pragmatic approach we analysed the costs and the effectiveness of these 2 types of structures delivering oxygen at home. Between July 1985 and March 1994, 234 patients were involved in the survival study (chosen as an effectiveness indicator), 24% in PM and 76% in NP. The economic appraisal was performed, from the insurer's point of view, on a representative sample of 61 patients and analysed in detail all the ambulatory costs for respiratory care. Patient survival was similar in both types of structures (Cox model). Oxygen therapy represented the largest share of the total ambulatory cost (81.6% in PM and 72.1% in NP). The NP structures were less costly for reasons linked to their preference for concentrator (p = 0.004 in a Wilcoxon test), all the other direct costs being non-statistically different. NP structures had a significant influence on a low level of ambulatory costs (adjusted OR = 10.98, p = 0.0004) in logistic regression. As oxygen treatment plays an important role in the variation of costs, further pragmatic studies should help to better understand what are the real motivations to choose one mode of oxygen administration more than an other and should determine factors that may sometimes lead physicians not to comply with clinical guidelines (actually a quarter of the patients did not have a PaO2 < 60 mmHg).
在法国，慢性阻塞性肺疾病（COPD）患者的家庭氧疗由非营利性协会（NP）或营利性健康组织（PM）开展。我们采用回顾性务实方法，分析了这两种提供家庭氧气的机构的成本和效果。1985年7月至1994年3月，234名患者参与了生存研究（选为效果指标），其中24%在PM机构，76%在NP机构。从保险公司的角度，对61名患者的代表性样本进行了经济评估，并详细分析了所有呼吸护理的门诊费用。两种机构的患者生存率相似（Cox模型）。氧疗在门诊总费用中占比最大（PM机构为81.6%，NP机构为72.1%）。NP机构成本较低，原因与它们更倾向于使用制氧机有关（Wilcoxon检验中p = 0.004），所有其他直接费用无统计学差异。在逻辑回归中，NP机构对低门诊费用有显著影响（调整后OR = 10.98，p = 0.0004）。由于氧疗在费用变化中起重要作用，进一步的务实研究应有助于更好地理解选择一种氧疗方式而非另一种的真正动机，并应确定有时可能导致医生不遵守临床指南的因素（实际上四分之一的患者动脉血氧分压未<60 mmHg）。
