Cost-Effectiveness of Specialized Multidisciplinary Heart Failure Clinics in Ontario, Canada
Cost-Effectiveness of Specialized Multidisciplinary Heart Failure Clinics in Ontario, Canada
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DOI：
10.1111/j.1524-4733.2010.00797.x
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发表时间：
2010-12-01
期刊：
影响因子：
4.5
通讯作者：
Krahn, Murray
中科院分区：
文献类型：
--
作者：
Wijeysundera, Harindra C.;Machado, Marcio;Krahn, Murray
背景：专门的多学科诊所被证明可以降低心力衰竭(HF)的死亡率。我们的目标是评估这种护理模式的成本效益。方法：我们从安大略省卫生和长期护理部的角度进行了12年时间跨度的成本效益分析，比较了2005年所有入院的心衰患者组成的标准护理队列和在心衰诊所接受治疗的假想队列。描述心力衰竭自然病史的生存曲线是使用有效心脏治疗(Effect)增强反馈研究中的死亡率估计来构建的。通过对已发表试验的荟萃分析，估计了与心力衰竭诊所相关的生存收益和资源摄取。心力衰竭诊所的费用是通过计算安大略省一家有代表性的诊所的成本来获得的。与健康相关的费用通过与行政数据库的链接来确定。结果：心力衰竭诊所可使全因死亡率降低29%(风险比为0.71；95%可信区间为0.56-0.91)，但住院率增加12%(风险比为1.12；95%可信区间为0.92-1.135)。心力衰竭诊所的护理费用为每30个病人日52美元。心力衰竭门诊患者的预期寿命为3.91岁，而标准护理为3.21岁。心力衰竭诊所组每名患者12年的累积成本为66,532美元，而标准护理组为53,638美元。ICER为18,259美元/生命年收益。结论：心力衰竭诊所似乎是为心力衰竭患者提供门诊护理的一种经济有效的方式。
Background:Specialized multidisciplinary clinics have been shown to reduce mortality in heart failure (HF). Our objective was to evaluate the cost-effectiveness of this model of care delivery.Methods:We performed a cost-effectiveness analysis, with a 12-year time horizon, from the perspective of the Ontario Ministry of Health and Long-term Care, comparing a standard care cohort, consisting of all patients admitted to hospital with HF in 2005, to a hypothetical cohort treated in HF clinics. Survival curves describing the natural history of HF were constructed using mortality estimates from the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. Survival benefits and resource uptake associated with HF clinics were estimated from a meta-analysis of published trials. HF clinics costs were obtained by costing a representative clinic in Ontario. Health-related costs were determined through linkage to administrative databases. Outcome measures included life expectancy (years), costs (in 2008 Canadian dollars) and the incremental cost-effectiveness ratio (ICER).Results:HF clinics were associated with a 29% reduction in all-cause mortality (risk ratio [RR] 0.71; 95% confidence interval [CI] 0.56-0.91) but a 12% increase in hospitalizations (RR 1.12; 95% CI 0.92-1.135). The cost of care in HF clinics was $52 per 30 patient-days. Projected life-expectancy of HF clinic patients was 3.91 years, compared to 3.21 years for standard care. The 12-year cumulative cost per patient in the HF clinic group was $66,532 versus $53,638 in the standard care group. The ICER was $18,259/life-year gained.Conclusions:HF clinics appear to be a cost effective way of delivering ambulatory care to HF patients.