The Cost-Effectiveness of the Decision to Hospitalize Nursing Home Residents With Advanced Dementia
The Cost-Effectiveness of the Decision to Hospitalize Nursing Home Residents With Advanced Dementia
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DOI：
10.1016/j.jpainsymman.2012.11.007
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发表时间：
2013-11-01
影响因子：
4.7
通讯作者：
Mitchell, Susan L.
中科院分区：
文献类型：
--
作者：
Goldfeld, Keith S.;Hamel, Mary Beth;Mitchell, Susan L.
上下文患有晚期痴呆症的疗养院（NH）居民通常会经历负担沉重和昂贵的住院治疗，这可能不会延长生存期或改善生活质量。这些居民住院决策的成本效益分析尚未得到证实。评估NH居民中晚期痴呆患者1）没有不住院（DNH）命令和2）因疑似肺炎住院的成本-效果。在2003年2月至2009年2月期间进行的生命末期晚期痴呆症护理的选择，态度和策略研究中，对波士顿地区22个NH的NH居民进行了随访。我们进行了积极的治疗策略的成本效益分析，先进的痴呆症居民生活在NHs时，他们患有急性疾病。主要结果指标包括质量调整生命日（QALD）和质量调整生命年、医疗保险支出和15个月以上的增量净收益（INB）。与避免医院转移的不太积极的策略（即，有DNH订单），住院治疗策略与医疗保险支出的5972美元增量增加和质量调整生存率的3.7 QALD增量增加相关。肺炎住院治疗与医疗保险支出增加3697美元和质量调整生存率减少9.7 QALD相关。在100，000美元/质量调整生命年的意愿支付水平下，更积极的治疗策略的INB为负，因此不具有成本效益（没有DNH订单的INB为-4958美元，因肺炎转移到医院的INB为-6355美元）。有利于晚期痴呆症NH居民住院治疗的治疗策略不具有成本效益。(C)2013年美国癌症疼痛缓解委员会。爱思唯尔公司出版All rights reserved.
Context. Nursing home (NH) residents with advanced dementia commonly experience burdensome and costly hospitalizations that may not extend survival or improve quality of life. Cost-effectiveness analyses of decisions to hospitalize these residents have not been reported.Objectives. To estimate the cost-effectiveness of 1) not having a do-not-hospitalize (DNH) order and 2) hospitalization for suspected pneumonia in NH residents with advanced dementia.Methods. NH residents from 22 NHs in the Boston area were followed in the Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life study conducted between February 2003 and February 2009. We conducted cost-effectiveness analyses of aggressive treatment strategies for advanced dementia residents living in NHs when they suffer from acute illness. Primary outcome measures included quality-adjusted life days (QALD) and quality-adjusted life years, Medicare expenditures, and incremental net benefits (INBs) over 15 months.Results. Compared with a less aggressive strategy of avoiding hospital transfer (i.e., having DNH orders), the strategy of hospitalization was associated with an incremental increase in Medicare expenditures of $5972 and an incremental gain in quality-adjusted survival of 3.7 QALD. Hospitalization for pneumonia was associated with an incremental increase in Medicare expenditures of $3697 and an incremental reduction in quality-adjusted survival of 9.7 QALD. At a willingnessto-pay level of $100,000/quality-adjusted life years, the INBs of the more aggressive treatment strategies were negative and, therefore, not cost effective (INB for not having a DNH order, -$4958 and INB for hospital transfer for pneumonia, -$6355).Conclusion. Treatment strategies favoring hospitalization for NH residents with advanced dementia are not cost effective. (C) 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.