Maltoni M, Travaglini C, Santi M, Nanni O, Scarpi E, Benvenuti S, Albertazzi L, Amaducci L, Derni S, Fabbri L, Masi A, Montanari L, Pasini G, Polselli A, Tonelli U, Turci P, Amadori D
Divisione Oncologia Medica, Ospedale Pierantoni, Forlì, Italy.
Support Care Cancer. 1997 Sep;5(5):396-401. doi: 10.1007/s005200050098.
The aim of this work was to carry out a cost evaluation of the home care programme for terminally ill cancer patients run by the Istituto Oncologico Romagnolo (I.O.R.) in the areas of Forlì, Cesena, Ravenna and Rimini (Romagna, Italy). To determine effective home care direct costs, we first selected 1 week of care as an observation unit. We then proceeded to assess the medical and nursing care units together with the clinical protocols administered for each patient. The Karnofsky Performance Status (KPS) was also assessed weekly. In this way, we calculated care costs for each patient and for each week as the sum of medical costs, nursing costs, treatment costs and other costs. A consecutive series of 574 patients were involved in the study from 1 April 1994 to 31 March 1995. A total of 5164 patient-weeks of care was provided, with an average cost per week of 177.6 Ecu. This weekly cost increased in the last 100 days of life (week -15 = 179.5 Ecu; week -8 = 188.3 Ecu; week -2 = 221.0 Ecu; P < 0.001). When single components were analysed in relation to total cost (treatment protocols, physician and nursing care) the increased global cost was found to be mainly attributable to the intensification in nursing care (21.8% of costs in week -15 vs 27.3% of costs in week -2). Examination of the relation between the cost of 1 week of care and KPS values clearly shows that healthcare costs increased as KPS decreased (from 152.2 Ecu with KPS > or = 60 to 292.6 Ecu with KPS < or = 20; P < 0.001). Home care costs were also seen to vary with some clinical characteristics and symptoms present when patients entered the study: asthenia, anorexia, nausea/vomiting, bedsores. Given the good results of home care for cancer patients in terms of quality of life, this method of cost accounting for home-care providers can help to monitor the rising cost of assistance and confirm the cost effectiveness of this type of care.
这项工作的目的是对由罗马涅肿瘤研究所（I.O.R.）在意大利罗马涅地区的弗利、切塞纳、拉文纳和里米尼开展的晚期癌症患者家庭护理项目进行成本评估。为确定有效的家庭护理直接成本，我们首先选取1周的护理作为观察单位。然后我们着手评估医疗和护理单元以及为每位患者实施的临床方案。还每周评估卡氏功能状态评分（KPS）。通过这种方式，我们将每位患者每周的护理成本计算为医疗成本、护理成本、治疗成本和其他成本的总和。从1994年4月1日至1995年3月31日，连续的574例患者参与了该研究。总共提供了5164个患者护理周，每周平均成本为177.6欧洲货币单位。在生命的最后100天，每周成本有所增加（第 -15周 = 179.5欧洲货币单位；第 -8周 = 188.3欧洲货币单位；第 -2周 = 221.0欧洲货币单位；P < 0.001）。当分析单个组成部分与总成本（治疗方案、医生和护理）的关系时，发现总成本增加主要归因于护理强化（第 -15周成本的21.8%与第 -2周成本的27.3%）。对1周护理成本与KPS值之间关系的检查清楚表明，随着KPS降低，医疗保健成本增加（KPS≥60时为152.2欧洲货币单位，KPS≤20时为292.6欧洲货币单位；P < 0.001）。家庭护理成本还因患者进入研究时存在的一些临床特征和症状而有所不同：乏力、厌食、恶心/呕吐、褥疮。鉴于家庭护理在癌症患者生活质量方面取得的良好效果，这种家庭护理提供者的成本核算方法有助于监测援助成本的上升，并确认此类护理的成本效益。
