Economic analysis of implementing virtual reality therapy for pain among hospitalized patients
Economic analysis of implementing virtual reality therapy for pain among hospitalized patients
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DOI：
10.1038/s41746-018-0026-4
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发表时间：
2018-06-13
影响因子：
15.2
通讯作者：
Spiegel, Brennan M. R.
中科院分区：
文献类型：
--
作者：
Delshad, Sean D.;Almario, Christopher V.;Spiegel, Brennan M. R.
虚拟现实（VR）已经成为一种新颖而有效的非药物治疗疼痛的方法，并且在急性医院环境中使用VR的兴趣越来越大。我们试图探索VR治疗必须满足的成本和有效性阈值，以节省住院患者疼痛管理计划的成本。结果为医院管理者提供了一个框架，以评估实施不同效果和成本的住院虚拟现实计划的投资回报。利用决策分析软件，我们比较了住院患者的辅助VR治疗与常规护理的疼痛管理。在VR策略中，我们分析了减少阿片类药物使用和住院时间（LOS）所带来的潜在成本节约，以及通过医院消费者对医疗保健提供者和系统的评估（HCAHPS）调查测量的更高的患者满意度所带来的报销增加。与常规护理相比，VR计划平均每位患者节省的住院总费用为5.39美元（95%置信区间- 11.00美元至156.17美元）。在对1000家不同规模和人员配备的假想医院进行的概率敏感性分析中，VR在89.2%的试验中仍然节省了成本。VR项目只要能将LOS降低14.6%，就能节约成本；该模型对阿片类药物使用或HCAHPS的差异不敏感。我们得出结论，住院虚拟现实治疗可能主要是节省医院系统的成本，如果它减少LOS。单独来看，减少阿片类药物使用所节省的费用和增加与hcahps相关的报销不足以克服虚拟现实的成本。
Virtual reality (VR) has emerged as a novel and effective non-pharmacologic therapy for pain, and there is growing interest to use VR in the acute hospital setting. We sought to explore the cost and effectiveness thresholds VR therapy must meet to be cost-saving as an inpatient pain management program. The result is a framework for hospital administrators to evaluate the return on investment of implementing inpatient VR programs of varying effectiveness and cost. Utilizing decision analysis software, we compared adjuvant VR therapy for pain management vs. usual care among hospitalized patients. In the VR strategy, we analyzed potential cost-savings from reductions in opioid utilization and hospital length of stay (LOS), as well as increased reimbursements from higher patient satisfaction as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The average overall hospitalization cost-savings per patient for the VR program vs. usual care was $5.39 (95% confidence interval -$11.00 to $156.17). In a probabilistic sensitivity analysis across 1000 hypothetical hospitals of varying size and staffing, VR remained cost-saving in 89.2% of trials. The VR program was cost-saving so long as it reduced LOS by >= 14.6%; the model was not sensitive to differences in opioid use or HCAHPS. We conclude that inpatient VR therapy may be cost-saving for a hospital system primarily if it reduces LOS. In isolation, cost-savings from reductions in opioid utilization and increased HCAHPS-related reimbursements are not sufficient to overcome the costs of VR.