Rehabilitation and care after hip fracture: a cost-utility analysis of stepped-wedge cluster randomized trial.

IF 2.5 4区 医学 Q1 REHABILITATION Journal of Rehabilitation Medicine Pub Date : 2024-11-21 DOI:10.2340/jrm.v56.40897
Jonas A Ipsen, Jan Abel Olsen, Bjarke Viberg, Lars T Pedersen, Inge H Bruun, Eva Draborg
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Abstract

Objective: To estimate the effectiveness and costs of Rehabilitation for Life (RFL) compared with usual rehabilitation and care after hip fracture to determine which course offered the most value for money.

Design: Cost-utility analysis.

Patient: Community-dwelling patients aged 65+ after hip fracture.

Method: 123 intervention and 122 control patients were included. Data was collected at 5 points from discharge to 1-year follow-up. Cost analysis included expenses to hospital, general practice, specialist services, medications, rehabilitation, home and informal care, transport, and waiting times. The primary outcome was the incremental cost per quality-adjusted life year (QALY).

Results: The intervention group experienced a statistically significant mean QALY gain of 0.02 -compared with the control group. The intervention was more costly by €4,224, resulting in an incremental cost of €159,990 per QALY gained. Two municipalities had several patients in respite care, yielding an imbalance. A subanalysis excluding these patients demonstrated QALY gain at 0.03 and the cost difference of €2,586 was not statistically significant.

Conclusion: The intervention demonstrated a slight improvement in effectiveness over the control but was costly. For patients not requiring respite care, the intervention effect was slightly higher, and the cost differences statistically insignificant. In total 91% received informal care and the economic contribution of informal care exceeded the municipal home care services.

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髋部骨折后的康复和护理:阶梯式楔形群随机试验的成本效用分析。
目的估算髋部骨折后 "生命康复"(RFL)与常规康复和护理相比的效果和成本,以确定哪种课程最物有所值:设计:成本效用分析:患者:65 岁以上在社区居住的髋部骨折患者:方法:纳入 123 名干预患者和 122 名对照患者。从出院到 1 年随访,在 5 个时间点收集数据。成本分析包括医院、全科诊所、专科服务、药物、康复、家庭和非正式护理、交通和等待时间的费用。主要结果是每质量调整生命年(QALY)的增量成本:与对照组相比,干预组的平均质量调整生命年收益为 0.02,具有显著的统计学意义。干预组的成本比对照组高 4,224 欧元,因此每个质量调整生命年的增量成本为 159,990 欧元。有两个城市有几名患者接受了临时护理,造成了不平衡。排除这些患者后进行的子分析表明,QALY收益为0.03,而2586欧元的成本差异在统计学上并不显著:结论:与对照组相比,干预效果略有改善,但成本较高。对于不需要临时护理的患者,干预效果略高,成本差异在统计学上不显著。共有 91% 的患者接受了非正规护理,非正规护理的经济贡献超过了市政家庭护理服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.60
自引率
5.70%
发文量
102
审稿时长
4-8 weeks
期刊介绍: Journal of Rehabilitation Medicine is an international peer-review journal published in English, with at least 10 issues published per year. Original articles, reviews, case reports, short communications, special reports and letters to the editor are published, as also are editorials and book reviews. The journal strives to provide its readers with a variety of topics, including: functional assessment and intervention studies, clinical studies in various patient groups, methodology in physical and rehabilitation medicine, epidemiological studies on disabling conditions and reports on vocational and sociomedical aspects of rehabilitation.
期刊最新文献
Embedding rehabilitation into cancer care continuum: an implementation study. Exploring international classification of functioning, disability and health applicability for coding work-related disability: a study on depression and fibromyalgia in Swedish sick leave certificates. Rehabilitation and care after hip fracture: a cost-utility analysis of stepped-wedge cluster randomized trial. Upper limb muscle strength and wheelchair-related abilities following an exoskeleton-assisted walking programme in individuals with chronic spinal cord injury: An exploratory study. Factors associated with pain-related functional interference in people with chronic low back pain enrolled in a physical exercise programme: the role of pain, sleep, and quality of life.
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