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：在德国，目前痴呆症（PwDs）患者的数量估计为150万。鉴于预期寿命的增加和较高年龄组人数的增加，到2050年，痴呆症病例的数量估计将翻一番。此外，痴呆症与大量的医疗费用有关。因此，老龄化社会加上日益增加的患病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是看不见的，有相当大的需要更有效的痴呆症护理方法，如护理和病例管理计划。痴呆症护理管理计划的经济评估产生了不确定的证据，缺乏长期的研究。在德国进行的评价仍然missing.Objectives：目标是学习的方法来执行最佳实践的成本效用分析的DelphHi干预。这项工作应与加拿大麦克马斯特大学临床流行病学和生物统计学系卫生经济学副教授Feng Xie密切合作进行。基于学习的最佳实践方法，目的是评估DelphHi干预的增量成本效益比（ICER）。因此，（1）应将使用健康调查简表12（SF-12）测量的健康相关生活质量（HRQoL）转换为基于偏好的值，（2）必须计算质量调整生命年（QQL）。为了评估ICER，（3）最后必须比较DelpHi试验中干预组和对照组的QORs和总成本，包括干预成本和医疗成本。研究设计：本分析基于DelpHi-MV研究（痴呆症：在梅克伦堡-西波美拉尼亚提供以生活和个人为中心的帮助），一名全科医生，在初级保健环境中进行的随机分组对照干预试验。干预措施旨在通过整合多专业和多模式策略提供最佳护理，以个性化和优化痴呆症的治疗，由痴呆症护理经理，接受过痴呆症专门培训的护士进行。DCM开发和实施一个干预计划量身定制的个人条件的PwD密切合作与GPS.Sample：符合条件的患者（70岁及以上，住在家里）进行了筛选，在GP的做法痴呆症。6，838人接受了125名全科医生的筛查。105名全科医生中的1，166名患者有资格参加这项研究。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。随访1于2016年3月完成，共有408名参与者。随访2于2017年3月完成，共有350名参与者。计算ICER的数据基础应该是DelpHi-MV研究的基线评估、随访1和随访2。预期结果：DelpHi-Intervention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.