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一个前性的多中心分析移动中风器的成本效益
Suja S Rajan1, Jose-Miguel Yamal2, Mengxi Wang2
1Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX.
Annals of neurology
|December 3, 2024
概括
移动中风单位 (MSU) 显示,对于所有缺血性中风患者来说,最初的边缘性成本效益. 然而,MSU对于没有先前残疾的患者来说变得非常具有成本效益,考虑到终身成本和中风相关费用.
科学领域:
- 神经学 神经学
- 卫生经济学 卫生经济学
- 紧急医疗服务 紧急医疗服务
背景情况:
- 缺血性中风带来了重大的疾病和财务负担.
- 及时服用血栓抑制剂对于有效的中风管理至关重要.
- 评估新的方法,如移动中风单位 (MSU) 对于中风治疗至关重要.
研究的目的:
- 与标准的紧急医疗服务 (EMS) 相比,评估移动中风单位 (MSU) 的成本效益,以加快组织等离子素激活剂 (tPA) 的管理.
- 使用增量成本效益比率 (ICER) 方法分析一年和终身成本效益.
主要方法:
- 一个前性,多中心,交替周,集群控制的试验,比较MSU和EMS.
- 通过EQ-5D-5L数据估计的质量调整寿命年 (QALYs) 作为主要有效性指标.
- 基于医疗保险补偿金的成本分析,包括不包括先前存在的残疾和仅限于中风相关成本的计算.
主要成果:
- 第一年的ICER为所有tPA资格患者的238,873美元/QALY,对于没有先前存在的残疾患者的61,199美元/QALY.
- 所有患者的终身ICER为94,710美元/QALY,那些没有先前存在的残疾的人为31,259美元/QALY.
- 当仅限于与中风相关的成本时,ICERs下降,并受到每年每MSU患者治疗量的影响.
结论:
- MSU在第一年内对所有符合tPA资格的患者证明了边界成本效益,考虑到总成本.
- MSU对于没有先前存在的残疾的患者,在终身范围内,以及当专注于与中风相关的成本时,具有成本效益至非常高的成本效益.
- MSU的成本效益在很大程度上取决于患者数量和具体的成本参数.
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