量化改善结肠镜检查质量的节省成本和健康影响:经济评估
Stephen McCarthy1, Matthew David Rutter2,3, Peter McMeekin4
1Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK stephen.mccarthy@northumbria.ac.uk.
将英格兰的内镜服务提高到高质量标准,可以显著提高患者的健康结果,并每年为国家卫生服务节省数百万美元. 更高质量的护理带来了更多的质量调整寿命 (QALY) 和为所有人节省成本.
科学领域:
- 卫生经济学 卫生经济学
- 胃肠病学 胃肠病学
- 公共卫生政策 公共卫生政策
背景情况:
- 英格兰的内镜服务在性能上有所不同,这会影响患者的治疗结果.
- 结肠镜后结肠直肠癌 (PCCRC) 率是内镜质量的关键指标.
- 优化内镜性能对于医疗保健效率和患者福祉至关重要.
研究的目的:
- 量化增强英语内镜服务对健康的影响和成本影响.
- 通过使用后结肠镜检查结肠直肠癌 (PCCRC) 率来定义最佳质量.
- 评估实现高性能标准的经济和临床益处.
主要方法:
- 一个半马尔科夫状态过渡模型模拟了接受诊断结肠镜检查的个体.
- 该模型基于PCCRC率对高,中,低绩效内镜服务信托进行了比较.
- 经质量调整的寿命年数 (QALYs) 和总成本为年龄在4090.0的模拟队列计算.
主要成果:
- 从中等到高绩效信托的改善产生了0.0006个QALY和每人6.75英的储蓄.
- 从低绩效信托改为高绩效信托,每个人节省了0.0012 QALY和14.64英.
- 将所有低/中级信托升级为高性能信托可以为NHS节省约2.49亿英,并为英国人口 (年龄在40-86岁) 获得超过14.000个QALY.
结论:
- 提高内镜服务质量可以明显提高人口的QALY.
- 内镜性能的提高为医疗保健提供者带来了显著的成本节省.
- 将所有表现不佳的信托升级为高质量标准是NHS的成本有效策略,每年可能节省500万英.
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