Cost effectiveness of training rural providers to perform joint injections.
Cost effectiveness of training rural providers to perform joint injections.
复制标题
培训农村提供者进行联合注射的成本效益。
DOI：
10.1002/acr.22179
复制
发表时间：
2014
影响因子：
4.7
通讯作者：
Cannon,GrantW
中科院分区：
文献类型：
--
作者：
Nelson,RichardE;Battistone,MichaelJ;Ashworth,WilliamD;Barker,AndreaM;Grotzke,Marissa;Huhtala,TimothyA;Lafleur,Joanne;Tashjian,RobertZ;Cannon,GrantW
目的退伍军人事务部（VA）建立了社区门诊诊所（CBOCs），为生活在偏远和农村地区的退伍军人提供初级保健服务。本研究的目的是评估培训农村初级保健提供者在CBOC进行膝关节注射的成本效益，从而避免将患者转诊到城市医疗中心接受风湿病学或骨科专家的注射。方法我们开发了一个决策分析模型，比较接受过膝关节注射培训的农村提供者与未接受过膝关节注射培训的农村提供者之间的成本和结果，因此需要转诊给专科医生提供注射。从VA的角度以及从患者的角度来看，该模型分别使用成本运行。有效性结局为质量调整生命年（Qs）。使用10，000次二阶蒙特卡罗模拟进行概率敏感性分析。结果在我们的基础病例分析中，从VA的角度来看，经过培训的农村提供者的增量成本效益比为21，190/QALY，从患者的角度来看，使用成本为205/QALY。培训农村提供者的成本效益在74.4%和93.6%的10，000蒙特卡罗模拟在一个愿意支付阈值为50，000/QALY从VA和patients. Conclusiontrainingruralproviderstoperformkneeinjections为患者膝关节疼痛继发于骨关节炎出现scosteffectively使用共同使用的阈值50，000/QALY，如果超过20这样的患者每年都看到在农村初级保健诊所。这些结果为我们正在进行的实施此类培训计划的努力提供了支持。
Objective Community‐based outpatient clinics (CBOCs) have been established by the Department of Veterans Affairs (VA) to provide primary care services to veterans living in remote and rural regions. The objective of this study was to evaluate the cost effectiveness of training rural primary care providers to perform knee injections in CBOCs, thereby avoiding referring the patient to an urban medical center for an injection by rheumatology or orthopedic specialists. Methods We developed a decision‐analysis model to compare costs and outcomes between rural providers who are trained to perform knee injections versus those who are not trained, therefore requiring a referral to a specialist to provide the injections. The model was run separately using costs from the perspective of the VA as well from the patient's perspective. The effectiveness outcome was quality‐adjusted life years (QALYs). Probabilistic sensitivity analyses were performed using 10,000 second‐order Monte Carlo simulations. Results In our base‐case analyses, the incremental cost‐effectiveness ratio for trained rural providers was 21,190/QALYusingcostsfromtheperspectiveoftheVAand 205/QALY using costs from the patient's perspective. Training rural providers was cost effective in 74.4% and 93.6% of 10,000 Monte Carlo simulations at a willingness‐to‐pay threshold of 50,000/QALYfromtheperspectivesoftheVAandthepatient,respectively.ConclusionTrainingruralproviderstoperformkneeinjectionsforpatientswithkneepainsecondarytoosteoarthritisappearscosteffectiveusingthecommonlyusedthresholdof 50,000/QALY if more than 20 such patients per year are seen at rural primary care clinics. These results provide support for our ongoing efforts to implement such a training program.