Cost effectiveness of the occupation-based approach for subacute stroke patients: result of a randomized controlled trial
Cost effectiveness of the occupation-based approach for subacute stroke patients: result of a randomized controlled trial
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亚急性卒中患者基于职业的方法的成本效益：随机对照试验的结果
DOI：
10.1080/10749357.2017.1289686
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Yamauchi Keita
中科院分区：
文献类型：
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作者：
Nagayama Hirofumi;Tomori Kounosuke;Ohno Kanta;Takahashi Kayoko;Nagatani Ryutaro;Izumi Ryota;Moriwaki Kensuke;Yamauchi Keita
背景与目的：作业疗法对亚急性脑卒中患者的成本效益在现有文献中尚不清楚。因此，本研究确定的成本效益的职业为基础的方法，使用辅助决策的职业选择（ADOC）为亚急性中风patients相比，一个基于损伤的approach.Methods：我们进行了经济评估，从社会的角度来看，旁边的试点随机对照试验，与一个单盲评估参与者在日本的10个亚急性康复单位。干预组接受基于职业的目标设定，使用ADOC，干预措施集中在有意义的职业。对照组接受基于损伤的方法，重点是恢复能力。对两组患者每周进行5次以上的职业治疗干预，每次40 min以上，出院前接受物理和语言治疗。主要结果是质量调整生命年（QDs）和总成本。此外，进行敏感性分析，以检查参数的不确定性对基础case results.Results的影响：最终的参与者人数为24人，在两组。在QOLS方面，干预组显著高于对照组（p= 0.001，差异95%CI：0.002-0.008），总成本无统计学意义。结论：与基于损伤的评估方法相比，基于职业的评估方法能够显著提高QALY，具有潜在的成本效益。
Background and purpose:The cost effectiveness of occupational therapy for subacute stroke patients is unclear in the extant literature. Consequently, this study determined the cost effectiveness of the occupation-based approach using Aid for Decision-Making in Occupation Choice (ADOC) for subacute stroke patients compared with an impairment-based approach.Methods:We conducted an economic evaluation from a societal perspective alongside a pilot randomized controlled trial, with a single blind assessor for participants in 10 subacute rehabilitation units in Japan. The intervention group received occupation-based goal setting using ADOC, with interventions focused on meaningful occupations. The control group received an impairment-based approach focused on restoring capacities. For both groups, occupational-therapy intervention was administered more than five times per week, for over 40 min each time, and they received physical and speech therapy prior to discharge. The main outcomes were quality-adjusted life years (QALYs) and total costs. Further, sensitivity analyses were performed to examine the influence of parameter uncertainty on the base case results.Results:The final number of participants was 24 in each of the two groups. In terms of QALYs, the intervention group is significantly higher than the control group (p= 0.001, difference 95% CI: 0.002–0.008) and total costs are not statistically significant. Applying a willingness-to-pay threshold of JPY 5 million/QALY, the probability of the occupation-based approach using ADOC being cost effective was estimated to be 65.3%.Conclusions:The results show that the occupation-based approach is associated with significantly improved QALYs and has potential cost effectiveness, compared with the impairment-based approach.