Cost-effectiveness of rehabilitation after an acute coronary event: a ranclornised controlled trial
Cost-effectiveness of rehabilitation after an acute coronary event: a ranclornised controlled trial
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DOI：
10.5694/j.1326-5377.2005.tb07121.x
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发表时间：
2005-11-07
影响因子：
11.4
通讯作者：
Keech, AC
中科院分区：
文献类型：
--
作者：
Briffa, TG;Eckermann, SD;Keech, AC
目的：评估急性冠状动脉综合征后心脏康复对成本和生活质量的增量影响。设计：开放式随机对照试验，随访 1 年。分析以意向治疗为基础。地点：悉尼的两家三级医院。干预：18 次基于运动的综合门诊心脏康复或由主治医生提供的常规护理。参与者：113 名年龄在 41-75 岁之间、能自我照顾且懂英语的患者。患有失代偿性心力衰竭、不受控制的心律失常、严重和有症状的主动脉瓣狭窄或身体损伤的患者被排除在外。 主要结果指标： 费用（住院、药物使用、门诊就诊、检查和个人费用）；以及生活质量的衡量标准。 1 年时节省的每个质量调整生命年 (QALY) 的增量成本（该估计结合了研究内效用效应与报告的 1 年生存风险和康复治疗对死亡率的影响）。围绕基本案例估计的敏感性分析包括治疗对生存没有影响、3 年治疗对生存产生影响以及效用变化的替代假设。 结果：当模型包括报告的生存治疗影响时，相对于标准护理为康复节省的每个 QALY 的估计增量成本为 42 535 美元。如果不包括治疗对生存的影响，则每节省 QALY 则增加至 70 580 美元。结果对效用的变化很敏感，范围从每 QALY 节省 19685 美元到康复不具有成本效益。结论：对生活质量的影响往往会强化急性冠脉综合征出院后康复患者的治疗优势。每个 QALY 节省的估计基本案例增量成本与药品福利咨询委员会等决策机构历来接受的成本一致。
Objective: To estimate the incremental effects on cost and quality of life of cardiac rehabilitation after an acute coronary syndrome.Design: Open randomised controlled trial with 1 year's follow-up. Analysis was on an intention-to-treat basis.Setting: Two tertiary hospitals in Sydney.Intervention: 18 sessions of comprehensive exercise-based outpatient cardiac rehabilitation or conventional care as provided by the treating doctor.Participants: 113 patients aged 41-75 years who were self-caring and literate in English. Patients with uncompensated heart failure, uncontrolled arrhythmias, severe and symptomatic aortic stenosis or physical impairment were excluded.Main outcome measures: Costs (hospitalisations, medication use, outpatient visits, investigations, and personal expenses); and measures of quality of life. Incremental cost per quality-adjusted life year (QALY) saved at 1 year (this estimate combines within-study utility effects with reported 1-year risk of survival and treatment effects of rehabilitation on mortality). Sensitivity analyses around a base case estimate included alternative assumptions of no treatment effect on survival, 3 years of treatment effect on survival and variations in utility.Results: The estimated incremental cost per QALY saved for rehabilitation relative to standard care was $42 535 when modelling included the reported treatment effect on survival. This increased to $70 580 per QALY saved if treatment effect on survival was not included. The results were sensitive to variations in utility and ranged from $19685 per QALY saved to rehabilitation not being cost-effective.Conclusions: The effects on quality of life tend to reinforce treatment advantages on survival for patients having postdischarge rehabilitation after an acute coronary syndrome. The estimated base case incremental cost per QALY saved is consistent with those historically accepted by decision making authorities such as the Pharmaceutical Benefits Advisory Committee.