Health-economic evaluation of home telemonitoring for COPD in Germany: evidence from a large population-based cohort.
Health-economic evaluation of home telemonitoring for COPD in Germany: evidence from a large population-based cohort.
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DOI：
10.1007/s10198-016-0834-x
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发表时间：
2017-09
期刊：
影响因子：
--
通讯作者：
Stargardt T
中科院分区：
文献类型：
--
作者：
Achelrod D;Schreyögg J;Stargardt T
COPD的远程监护由于其降低发病率和死亡率、医疗保健利用率和成本的潜力而备受关注。然而，其在临床和经济结局方面的益处仍有待明确证明。分析欧洲最大的COPD远程监护试点项目对直接医疗费用、卫生资源利用和12个月死亡率的影响。我们使用管理数据评估了一个基于人群的队列。计算差异中的差异估计值，以解释时不变的不可观察的异质性后，删除可观察到的特征之间的差异的远程监护和控制组与重新加权算法。该分析包括651名远程监护参与者和标准护理组的7047名参与者。干预组的死亡风险比较低（HR 0.51，95% CI 0.30-0.86）。与COPD标准治疗相比，远程监护降低了895欧元（p < 0.05）的总成本，主要是由于（非常）严重的COPD患者的COPD相关住院费用节省（-1056欧元，p < 0.0001）。远程监护参与者使用医疗保健（全因和COPD相关）的强度较低，住院时间较短，住院时间较少，急诊和住院的比例较小（所有p < 0.0001）。对于（非常）重度COPD病例，死亡率、成本和医疗保健利用率的降低幅度更大。这是德国第一项证明COPD远程监护是降低12个月死亡率、医疗成本和利用率的可行策略的研究。与普遍的恐惧相反，降低护理强度似乎不会对健康结果产生不利影响。证据提供了强有力的支持，引入远程监护作为一个组成部分的情况下管理。
Telemonitoring for COPD has gained much attention thanks to its potential of reducing morbidity and mortality, healthcare utilisation and costs. However, its benefit with regard to clinical and economic outcomes remains to be clearly demonstrated. To analyse the effect of Europe’s largest COPD telemonitoring pilot project on direct medical costs, health resource utilisation and mortality at 12 months. We evaluated a population-based cohort using administrative data. Difference-in-difference estimators were calculated to account for time-invariant unobservable heterogeneity after removing dissimilarities in observable characteristics between the telemonitoring and control group with a reweighting algorithm. The analysis comprised 651 telemonitoring participants and 7047 individuals in the standard care group. The mortality hazards ratio was lower in the intervention arm (HR 0.51, 95 % CI 0.30–0.86). Telemonitoring cut total costs by 895 € (p < 0.05) compared to COPD standard care, mainly driven by savings in COPD-related hospitalisations in (very) severe COPD patients (−1056 €, p < 0.0001). Telemonitoring enrolees used healthcare (all-cause and COPD-related) less intensely with shorter hospital stays, fewer inpatient stays and smaller proportions of people with emergency department visits and hospitalisations (all p < 0.0001). Reductions in mortality, costs and healthcare utilisation were greater for (very) severe COPD cases. This is the first German study to demonstrate that telemonitoring for COPD is a viable strategy to reduce mortality, healthcare costs and utilisation at 12 months. Contrary to widespread fear, reducing the intensity of care does not seem to impact unfavourably on health outcomes. The evidence offers strong support for introducing telemonitoring as a component of case management.
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DOI：
10.1055/s-0030-1255637
发表时间：
2010-09-01
期刊：
Pneumologie (Stuttgart, Germany)
影响因子：
--
作者：
Pritzkuleit, R;Beske, F;Katalinic, A
通讯作者：
Katalinic, A
远程监控在医院入院中纳入现有临床服务的有效性，以加剧慢性阻塞性肺部疾病：研究人员盲目，多中心，随机对照试验。
DOI：
10.1136/bmj.f6070
发表时间：
2013-10-17
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Pinnock H;Hanley J;McCloughan L;Todd A;Krishan A;Lewis S;Stoddart A;van der Pol M;MacNee W;Sheikh A;Pagliari C;McKinstry B
通讯作者：
McKinstry B
影响因子：
5.4
作者：
Hainmueller, Jens
通讯作者：
Hainmueller, Jens
影响因子：
5.6
作者：
Austin, Peter C.;Stanbrook, Matthew B.;Gershon, Andrea S.
通讯作者：
Gershon, Andrea S.
影响因子：
--
作者：
Pedone, Claudio;Lelli, Diana
通讯作者：
Lelli, Diana