Cost-Effectiveness Analysis of a Capitated Patient Navigation Program for Medicare Beneficiaries with Lung Cancer.
Cost-Effectiveness Analysis of a Capitated Patient Navigation Program for Medicare Beneficiaries with Lung Cancer.
复制标题
针对肺癌医疗保险受益人的按人头付费患者导航计划的成本效益分析。
DOI：
10.1111/1475-6773.12333
复制
发表时间：
2016
影响因子：
3.4
通讯作者：
Jones,LovellA
中科院分区：
文献类型：
--
作者：
Shih,Ya-ChenTina;Chien,Chun-Ru;Moguel,Rocio;Hernandez,Mike;Hajek,RichardA;Jones,LovellA
目的评估对诊断为肺癌的医疗保险受益人实施患者导航（PN）计划的成本效益。数据来源/研究设置成本效益分析。研究设计：采用马尔可夫模型来捕获肺癌的疾病进展，并将PN服务的临床获益描述为治疗和护理协调的及时性。从付款人的角度来看，我们估计了生命周期成本、生命年（LY s）和质量调整生命年（QALY s），并在单向和概率敏感性分析中解决了不确定性。数据收集/提取方法模型输入从文献中提取，并补充了来自医疗保险和医疗补助服务中心示范项目的数据。主要结果相比，通常的护理，PN服务产生更高的成本，但也取得了更好的结果。增量成本和有效性分别为9，145和0.47 QALY，导致增量成本-效果比为19，312/QALY。单向敏感性分析表明，结果对捕获局部分期患者PN生存获益的参数最敏感。CE可接受性曲线显示，在社会支付意愿为50，000和100，000/QALY时，PN计划具有成本效益的概率分别为0.80和0.91。结论：建立一个有资本的PN计划对医疗保险中的肺癌患者具有成本效益。未来的研究应该评估同样的结论是否适用于其他癌症。
Objective To assess the cost‐effectiveness of implementing a patient navigation (PN) program with capitated payment for Medicare beneficiaries diagnosed with lung cancer. Data Sources/Study Setting Cost‐effectiveness analysis. Study Design A Markov model to capture the disease progression of lung cancer and characterize clinical benefits of PN services as timeliness of treatment and care coordination. Taking a payer's perspective, we estimated the lifetime costs, life years (LY s), and quality‐adjusted life years (QALY s) and addressed uncertainties in one‐way and probabilistic sensitivity analyses. Data Collection/Extraction Methods Model inputs were extracted from the literature, supplemented with data from a Centers for Medicare and Medicaid Services demonstration project. Principal Findings Compared to usual care, PN services incurred higher costs but also yielded better outcomes. The incremental cost and effectiveness was 9,145and0.47QALYs,respectively,resultinginanincrementalcost‐effectivenessratioof 19,312/QALY. One‐way sensitivity analysis indicated that findings were most sensitive to a parameter capturing PN survival benefit for local‐stage patients. CE‐acceptability curve showed the probability that the PN program was cost‐effective was 0.80 and 0.91 at a societal willingness‐to‐pay of 50,000and 100,000/QALY, respectively. Conclusion Instituting a capitated PN program is cost‐effective for lung cancer patients in Medicare. Future research should evaluate whether the same conclusion holds in other cancers.