Multicomponent targeted intervention to prevent delirium in hospitalized older patients - What is the economic value?
Multicomponent targeted intervention to prevent delirium in hospitalized older patients - What is the economic value?
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DOI：
10.1097/00005650-200107000-00010
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发表时间：
2001-07-01
期刊：
影响因子：
3
通讯作者：
Inouye, SK
中科院分区：
文献类型：
--
作者：
Rizzo, JA;Bogardus, ST;Inouye, SK
导论.谵妄，或急性意识模糊状态，是住院老年人中常见和严重的事件。目前的估计表明，每年有230多万老年人因谵妄住院，住院天数超过1 750万天，占医疗保险支出的40多亿美元（1994年美元）。最近有报道称，与接受常规医院护理的受试者相比，接受多组分靶向风险因素干预（MTI）策略预防谵妄的住院老年人谵妄风险降低了40%。(1)然而，在建议在临床实践中实施这一预防策略之前，还必须彻底审查其成本影响。本分析进行净成本评估MTI预防谵妄住院患者，医院收费和成本费用比数据链接到一个数据库的852名受试者，谁是治疗与MTI或常规护理。多变量回归方法被用来帮助隔离MTI对医院成本的影响，这些结果然后与我们早期的MTI对谵妄预防的影响相结合，以评估这种干预的成本效益。MTI显著降低了中度谵妄风险受试者的非干预费用，但在高危受试者中没有降低。当MTI干预费用包括在内时，MTI对中度风险队列的总体医疗费用没有显著影响，但增加了高危组的总体费用。由于MTI在不增加成本的情况下预防了中度风险组的谵妄，因此得出的结论是，对于中度风险的谵妄患者来说，它是一种具有成本效益的治疗选择。相比之下，结果表明，MTI是不符合成本效益的高风险的主题。
INTRODUCTION. Delirium, or acute confusional state, is a common and serious occurrence among hospitalized older persons. Current estimates suggest that delirium complicates hospital stays for more than 2.3 million older persons each year, involving more than 17.5 million hospital days and accounting for more than $4 billion (1994 dollars) of Medicare expenditures. A 40% reduction was recently reported in the risk for delirium among hospitalized older persons receiving a multicomponent targeted risk factor intervention (MTI) strategy to prevent delirium, compared with subjects receiving usual hospital care.(1) Before recommending that this preventive strategy be implemented in clinical practice, however, the cost implications must be thoroughly examined as well.METHODS. The present analysis performs net cost evaluations of the MTI for the prevention of delirium among hospitalized patients, Hospital charge and cost-to-charge ratio data are linked to a database of 852 subjects, who were treated with MTI or usual care. Multivariable regression methods were used to help isolate the impact of MTI on hospital costs, These results were then combined with our earlier work on the impact of the MTI on delirium prevention to assess the cost effectiveness of this intervention.RESULTS. The MTI significantly reduced nonintervention costs among subjects at intermediate risk for developing delirium, but not among subjects at high risk, When MTI intervention costs were included, MTI had no significant effect on overall health care costs in the intermediate risk cohort, but raised overall costs in the high risk group.CONCLUSIONS. Because the MTI prevented delirium in the intermediate risk group without raising costs, the conclusion reached is that it is a cost effective treatment option for patients at intermediate risk for developing delirium. In contrast, the results suggest that the MTI is not cost effective for subjects at high risk.