基于社区的防摔路径的效率和公平性:基于模型的健康经济评估
Joseph Kwon1, Hazel Squires2, Tracey Young2
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford OX2 6GG, UK.
社区防摔策略在成本效益方面存在差异. 反应性和联合反应性/自我指导方法是有效的,而建议的护理只有在考虑健康不平等时才是最佳的. 这两个因素对于决策至关重要.
科学领域:
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
- 老年学是一门学科.
背景情况:
- 有三个基于社区的防摔路径:反应性 (R),主动性 (P) 和自我指导 (SR).
- 英国的指导方针建议扩大所有途径 (推护理,RC),但其他组合是可能的.
- 评估这些效率和公平战略对于最佳实施至关重要.
研究的目的:
- 为了比较不同基于社区的防摔策略的效率和公平性.
- 根据成本效益和分配成本效益分析,确定最佳的防摔策略.
主要方法:
- 从40年时间的社会角度进行成本效益分析.
- 概率灵敏度分析以解决参数不确定性.
- 分布成本效益分析,共同评估效率和公平性.
主要成果:
- 反应式 (R) 和反应式/自我引用式 (R+SR) 策略具有成本效益,每次获得的QALY成本较低.
- 推护理 (RC) 在30,000英/QALY值是成本效益低下的,除非考虑到健康不平等的厌恶.
- 当决策者分享公众对健康不平等的厌恶时,RC变得最佳,特别是在老年人健康状况更差的场景中.
结论:
- 基于社区的最佳防摔策略取决于平衡效率和健康公平方面的考虑.
- 英国指南推的护理 (RC) 需要将健康不平等的厌恶纳入最佳考虑.
- 经济因素和公平因素对于有效的防摔政策至关重要.
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