Modelling the cost-utility of bio-electric stimulation therapy compared to standard care in the treatment of elderly patients with chronic non-healing wounds in the UK
Modelling the cost-utility of bio-electric stimulation therapy compared to standard care in the treatment of elderly patients with chronic non-healing wounds in the UK
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DOI：
10.1185/030079906x167705
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发表时间：
2007-04-01
影响因子：
2.3
通讯作者：
Guest, Julian F.
中科院分区：
文献类型：
--
作者：
Clegg, John P.;Guest, Julian F.
目标：评估生物电刺激治疗的成本-效用从英国国家卫生服务体系（NHS）的角度来看，将Posifect（*）与标准护理在患有> 6个月的慢性不愈合伤口的老年患者中进行比较。来自16周临床评价的临床和资源使用数据将具有痉挛性伤口的患者中的电刺激治疗与从标准赌博分析获得的效用数据相结合，以构建16周马尔可夫模型。该模型考虑临床医生决定继续患者先前的护理计划或使用生物电刺激治疗进行治疗。2005/2006年价格的单位资源成本被应用于模型内的资源利用率估计，使生物电刺激治疗与标准护理相比的成本效用得到估计。在进行本研究时，尚未确定Posifect的收购成本。因此，基础病例分析使用的成本为50每dressing.Results：33%的所有伤口预计愈合后16周内开始的生物电刺激治疗。因此，使用生物电刺激治疗预计将导致辅助临床医生就诊次数减少51%，从每周4.7次减少到2.3次。该模型还表明，使用生物电刺激疗法而不是患者的标准护理，预计将使NHS管理他们的成本从2287磅（95% CI：1838; 2735磅）降低16%至1921磅（95% CI：1609; 2233磅），并在16周内获得0.023 Qs的健康收益。因此，生物电刺激疗法被认为是一种主要的治疗方法。敏感性分析表明，使用生物电刺激治疗相对于标准护理的成本效用对治疗的采购成本、患者药物的采购成本和临床医生就诊次数非常敏感，对其他敷料的效用值和采购成本不太敏感。在该模型的限制范围内，与标准护理相比，生物电刺激疗法有望为NHS提供一种具有成本效益的敷料，用于治疗持续时间> 6个月的慢性不愈合伤口。生物电刺激治疗的采购成本预计将通过减少对辅助临床医生访问的需求来抵消，从而释放NHS资源用于系统中的其他地方，从而提高NHS效率。
Objective: To estimate the cost-utility of bio-electric stimulation therapy (Posifect(*)) compared to standard care in elderly patients with chronic, non-healing wounds of > 6 months duration, from the perspective of the National Health Service (NHS) in the UK.Methods: Clinical and resource use data from a 16 week clinical evaluation of bio-electric stimulation therapy among patients who had recalcitrant wounds were combined with utility data obtained from a standard gamble analysis to construct a 16 week Markov model. The model considers the decision by a clinician to continue with a patient's previous care plan or treat with bio-electric stimulation therapy. Unit resource costs at 2005/2006 prices were applied to the resource utilisation estimates within the model, enabling the cost-utility of bio-electric stimulation therapy compared to standard care to be estimated. The acquisition cost of Posifect had not been decided at the time of performing this study. Hence, the base case analysis used a cost of 50 per dressing.Results: 33% of all wounds are expected to heal within 16 weeks after the start of bio-electric stimulation therapy. Consequently, using bio-electric stimulation therapy is expected to lead to a 51% decrease in the number of domiciliary clinician visits, from 4.7 to 2.3 per week. The model also showed that using bio-electric stimulation therapy instead of patients' standard care is expected to reduce the NHS cost of managing them by 16% from 2287 pound (95% CI: 1838; pound 2735) pound to 1921 pound (95% CI: 1609; pound 2233) pound and result in a health gain of 0.023 QALYs over 16 weeks. Hence, bio-electric stimulation therapy was found to be a dominant treatment. Sensitivity analyses demonstrated that the cost-utility of using bio-electric stimulation therapy relative to standard care is very sensitive to the acquisition cost of the therapy, the acquisition cost of patients' drugs and the number of clinician visits and less sensitive to utility values and the acquisition cost of other dressings.Conclusion: Within the limitations of the model, bio-electric stimulation therapy is expected to afford the NHS a cost-effective dressing compared to standard care in the management of chronic nonhealing wounds of > 6 months duration. Bio-electric stimulation therapy's acquisition cost is expected to be offset by a reduction in the requirement for domiciliary clinician visits, leading to a release of NHS resources for use elsewhere in the system, thereby generating an increase in NHS efficiency.