Cost-effectiveness-analysis of the Dementia-Care-Management by using the health survey SF-12 – Results of general practitioner based, cluster randomized, interventional trial DelpHi-MV

背景：德国目前的痴呆症(Pwds)人数估计达到150万人。鉴于预期寿命的增长和较高年龄组人口的增加，到2050年，痴呆症病例的数量估计将翻一番。此外，痴呆症与巨额医疗费用有关。因此，老龄化社会，加上日益增长的流行率和不断扩大的成本，是一个严重的医疗保健优先事项。由于痴呆症的因果治疗仍然遥遥无期，因此需要更有效的痴呆症护理方法，如护理和病例管理计划。对痴呆症护理管理项目的经济评估产生了不确定的证据，缺乏长期研究。在德国进行的评估仍然缺乏。目标：目的是学习进行德尔菲干预的最佳实践成本效用分析的方法。这应该与麦克马斯特大学(加拿大)临床流行病学和生物统计学系卫生经济学副教授谢锋密切合作。基于所学的最佳实践方法，目的是评估Delphi干预的增量成本效益比(ICER)。因此，(1)使用健康调查简表(SF-12)测量的健康相关生活质量(HRQOL)应转换为基于偏好的值；(2)必须计算质量调整的寿命年(QALY)。为了评估ICER，(3)QALYs和总成本，包括干预成本和医疗保健成本，最终必须在Delphi试验的干预和对照之间进行比较。研究设计：本研究基于Delphi-MV(痴呆症：梅克伦堡-西波美拉尼亚的以生活和个人为中心的帮助)研究，这是一项基于全科医生(GP)的、在初级保健环境中进行的整群随机对照干预试验。该干预措施旨在通过整合多专业和多模式战略来提供最佳护理，以个性化和优化痴呆症的治疗，由痴呆症护理经理、接受痴呆症专门培训的护士进行。DCM与全科医生密切合作，制定并实施了一项针对残疾人个体情况量身定做的干预计划。例如：符合条件的患者(70岁及以上，住在家里)在全科医生实践中进行痴呆症筛查。6838人接受了125名全科医生的筛查。105名全科医生中的1166名患者符合研究条件。634名参与者同意参与，94名全科医生的516名参与者开始了基线评估。后续行动1于2016年3月完成，共有408人参加。后续行动2于2017年3月完成，有350人参加。计算ICER的数据基础应是Delphi-MV研究的基线评估、随访1和随访2。预期结果：Delphi干预可能是全球首个具有成本效益的痴呆护理管理。

Background: The current number of persons with dementia (PwDs) is estimated to amount to 1.5 million in Germany. In light of the predicted increase in life expectancy and the rise of the number of persons in higher age groups, the number of dementia cases is estimated to double by 2050. Furthermore, dementia is associated with substantial healthcare costs. Thus, aging society coupled with increasing prevalence and with expanding costs is a serious healthcare priority. Since causal treatment of dementia is still out of sight, there is a considerable need for more effective ways of dementia care, like care and case management programs. Economic evaluations of dementia care management programs have produced inconclusive evidence and lacked on long-term studies. Evaluations conducted in Germany are still missing.Objectives: The objective is to learn the methods to perform a best-practice cost-utility-analysis of the DelpHi-Intervention. This should be done in close cooperation with Feng Xie, Associate Professor of Health Economics in the Department of Clinical Epidemiology and Biostatistics, McMaster University (Canada). Based on the learned best-practice method, the aim is to evaluate the incremental cost effectiveness ratio (ICER) of the DelpHi-Intervention. Therefore, (1) the health-related quality of life (HRQoL) measured by using the health survey Short Form 12 (SF-12) should be converted into preference-based values and (2) quality-adjusted life years (QALYs) have to be calculated. To evaluate the ICER, (3) QALYs and total cost, including both intervention cost and healthcare cost, finally have to be compared between intervention and controls of the DelpHi-trial.Study design: The present analysis is based on the study DelpHi-MV (Dementia: life- and person-centred help in Mecklenburg-Western Pomerania), a general practitioner (GP) based, cluster-randomized controlled intervention trial in a primary care setting. The intervention aims to provide optimum care by integrating multi-professional and multimodal strategies to individualize and optimize treatment of dementia, conducted by Dementia Care Managers, nurses with dementia-specific training. The DCM develops and implements an intervention plan tailored to the individual conditions of the PwD in close cooperation with the GP.Sample: Eligible patients (70 years and older, living at home) were screened in GP practices for dementia. 6,838 people were screened by 125 GPs. 1,166 patients of 105 GPs were eligible for the study. 634 participants agreed to participate, and 516 participants at 94 GPs started the baseline assessment. Follow-up 1 was completed with 408 participants in March 2016. Follow-up 2 was completed with 350 participants in March 2017. Data basis for the calculation of the ICER should be the baseline assessment, the follow up1 and the follow up 2 of the DelpHi-MV study.Expected results: The DelpHi-Intervention could be the first cost-effective dementia care management worldwide.