Telerehabilitation after total knee replacement in Italy: cost-effectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care
Telerehabilitation after total knee replacement in Italy: cost-effectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care
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DOI：
10.1136/bmjopen-2015-009964
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Turchetti, Giuseppe
中科院分区：
文献类型：
--
作者：
Fusco, Francesco;Turchetti, Giuseppe
目的评价全膝关节置换术（TKR）后远程康复治疗（TR）与标准康复治疗（SR）的成本效果和成本效用，并基于意大利国家卫生服务中心（NHS）的患者水平和二级数据源设计Markov决策模型进行成本效果和成本效用分析（NHS; Ita-NHS）和社会观点。设置意大利的初级保健单位（PCU）。参与者：TKR后出院的患者。干预混合SR-TR服务（10次面对面会议和10次会议）与SR（20次面对面会议）主要和次要结果测量与SR相比，SR-TR每增加一个膝关节屈曲活动范围（ROM）和每增加一个QALY的增量成本。第二，我们考虑了成本有效的概率和更有效、更便宜的概率。结果TR似乎是成本-在基本情况下和所有考虑的情况下都是有效的，但如果排除运输成本，就不再更有效和更便宜。将SR-TR与SR进行比较，采用Ita-NHS观点的基础病例增量成本效益比（ICER）为-117欧元/ROM。SR-TR的成本效益概率为0.98（上限比率：50欧元/ROM），而更有效和更便宜的联合概率为0.87。假设TR将使健康相关生活质量效用提高2.5%，采用Ita-NHS观点的ICER为-960欧元/QALY（成本效益概率：1;上限比率：30 000欧元/QALY）。所有敏感性分析均未改变结论，但如果排除运输成本，SR-TR更有效且更便宜的概率降低到0.56。结论SR-TR成本有效，如果PCU提供救护车运输，则更便宜且更有效。然而，与TR成本、HRQOL和长期临床结局相关的不确定性为未来的研究提出了重要课题，应予以解决以证实我们的估计。
Objectives To assess cost-effectiveness and cost utility of telerehabilitation (TR) versus standard rehabilitation (SR) after total knee replacement (TKR).Design Markov decision modelling of cost-effectiveness and cost-utility analysis based on patient-level and secondary data sources employing Italian National Health Service (NHS; Ita-NHS) and Society perspectives.Setting Primary care units (PCUs) in Italy.Participants Patients discharged after TKR.Interventions Mixed SR-TR service (10 face-to-face sessions and 10 telesessions) versus SR (20 face-to-face sessions)Primary and secondary outcome measures The incremental cost per additional knee flexion range of motion (ROM) and per QALY gained by SR-TR compared with SR. Second, we considered the probability of being cost-effective and the probability of being more effective and less expensive.Results TR appears to be the cost-effective in the base case and in all of the considered scenarios, but is no longer more effective and less expensive if transportation costs are excluded. Comparing SR-TR with SR, the incremental cost-effectiveness ratio (ICER) adopting the Ita-NHS perspective for the base case was -Euro117/ROM gained. The cost-effectiveness probability for SR-TR was 0.98 (ceiling ratio: Euro50/ROM), while the joint probability of being more effective and less expensive was 0.87. Assuming that TR would increase health-related quality of life (HRQOL) utilities by 2.5%, the ICER adopting Ita-NHS perspective is -Euro960/QALY (cost-effectiveness probability: 1; ceiling ratio: Euro30000/QALY). All the performed sensitivity analyses did not change the conclusions, but if transportation costs were excluded, the probability for SR-TR of being more clinically effective and less expensive reduced to 0.56.Conclusions The analysis suggested SR-TR to be cost-effective, even less expensive and more effective if the PCUs provide ambulance transportations. However, the uncertainty related to TR costs, HRQOL and long-term clinical outcomes raises important topics for future research, which should be addressed to confirm our estimates.Trial registration number ISRCTN45837371.