Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study
Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study
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DOI：
10.1136/bmjopen-2017-021256
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发表时间：
2018-08-01
期刊：
影响因子：
2.9
通讯作者：
Feder, Gene
中科院分区：
文献类型：
--
作者：
Barbosa, Estela Capelas;Verhoef, Talitha Irene;Feder, Gene
目的：利用常规临床实践中有关成本和有效性的最新真实信息，评估实施识别和转诊以提高安全性（IRIS）计划的成本效益。一个马尔可夫模型被构建来估计IRIS的平均成本和质量调整生命年（Qs）与普通护理的每名妇女注册在一个一般的做法，从社会和卫生服务的角度来看，10年的时间horizontal.Design和设置成本效用分析在英国的一般做法，包括数据从六个网站已经运行IRIS在英格兰至少2年。使用健康状况来代表干预的可能结果，我们规定了一个假设的队列10 000名年龄在16岁或以上的妇女。干预IRIS试验是一项随机对照试验，测试了初级保健培训和支持干预的有效性，以改善对遭受家庭暴力和虐待的妇女的反应，并发现它具有成本效益。因此，IRIS计划已在英国各地实施，结果IRIS项目为每名16岁或16岁以上的注册全科医生节省了14美元（95%的不确定性区间为-151磅至37磅），并产生每名女性0.001的QALY收益（95%的不确定性区间为-0.005至0.006）。从社会和国家卫生服务的角度来看，增量净货币效益都是积极的（42磅和22磅，IRIS项目的成本效益阈值为20磅000/QALY时，在61%的模拟中，使用真实生活数据，IRIS项目是成本效益的。结论IRIS项目很可能是成本-从英国的社会角度来看，有效和节省成本，从卫生服务的角度来看，具有成本效益，尽管这些结果存在相当大的不确定性，反映在较大的不确定性区间。
Objectives To evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon.Design and setting Cost-utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England.Participants Based on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older.Interventions The IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context.Results The IRIS programme saved 14 per woman aged 16 years or older registered in general practice (95% uncertainty interval -151 pound to 37) pound and produced QALY gains of 0.001 per woman (95% uncertainty interval -0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (42 pound and 22 pound, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was 20 pound 000 per QALY gained as advised by National Institute for Health and Care Excellence.Conclusion The IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.