基于患者报告结果的远程监测和警报干预对关节置换术后关键恢复期早期检测的成本效益:随机对照试验。

IF 15.8 1区 医学 Q1 Medicine PLoS Medicine Pub Date : 2024-10-09 eCollection Date: 2024-10-01 DOI:10.1371/journal.pmed.1004459
Lukas Schöner, David Kuklinski, Laura Wittich, Viktoria Steinbeck, Benedikt Langenberger, Thorben Breitkreuz, Felix Compes, Mathias Kretzler, Ursula Marschall, Wolfgang Klauser, Mustafa Citak, Georg Matziolis, Daniel Schrednitzki, Kim Grasböck, Justus Vogel, Christoph Pross, Reinhard Busse, Alexander Geissler
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引用次数: 0

摘要

背景:患者报告结果指标(PROMs)作为影响患者治疗路径的干预措施的有效性已在癌症治疗中得到证实,但在其他适应症中的有效性尚不清楚。我们评估了基于 PROM 的监测和警报干预措施的成本效益,该干预措施用于早期发现髋关节和膝关节置换术后的关键恢复路径:成本效益分析(CEA)基于一项多中心随机对照试验,该试验涵盖了 2019 年至 2020 年期间在德国 9 家医院接受髋关节置换术的 3697 名患者和膝关节置换术的 3110 名患者。该分析是在 546 例髋关节置换术和 492 例膝关节置换术的子集中进行的,其中的纵向费用数据来自 24 家法定医疗保险机构。患者按 1:1 随机分配到基于 PROM 的远程监控和警报干预组或标准护理组。所有患者均在术后 12 个月通过数字收集的 PROM 进行评估。干预组患者在术后 1 个月、3 个月和 6 个月接受额外评估,以便在出现关键恢复路径时与患者取得联系。为了进行效果评估,我们开发了一种基于 PROM 的综合测量方法(PRO-CM),将各种 PROM 的变化整合为一个范围从 0 到 100 的单一指数。PRO-CM包括6个PROM,重点关注生活质量和身心健康的各个方面。主要结果是增量成本效益比(ICER)。干预组显示,髋关节置换患者和膝关节置换患者的增量结果分别为 2.54 单位 PRO-CM(95% 置信区间 (CI) [0.93, 4.14];p = 0.002)和 0.87 单位 PRO-CM(95% 置信区间 (CI) [-0.94, 2.67];p = 0.347)。在术后 12 个月内,干预组髋关节置换术患者的费用较低,为 376.43 欧元(95% CI [-639.74, -113.12];p = 0.005),膝关节置换术患者的费用较低,为 375.50 欧元(95% CI [-767.40, 16.39];p = 0.060),表明这两种手术的 ICER 均占优势。然而,目前仍不清楚多阶段干预中哪一步对积极效果贡献最大:结论:与标准护理相比,干预能以较低的成本明显改善髋关节置换术患者的预后。此外,在膝关节置换术患者中,干预也显示出非显著的成本降低效果。这进一步证实了PROMs可作为一种经济有效的工具,用于标准护理环境下的远程监控:注册:德国临床研究注册中心(DRKS),注册号为 DRKS00019916。
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Cost-effectiveness of a patient-reported outcome-based remote monitoring and alert intervention for early detection of critical recovery after joint replacement: A randomised controlled trial.

Background: While the effectiveness of patient-reported outcome measures (PROMs) as an intervention to impact patient pathways has been established for cancer care, it is unknown for other indications. We assessed the cost-effectiveness of a PROM-based monitoring and alert intervention for early detection of critical recovery paths following hip and knee replacement.

Methods and findings: The cost-effectiveness analysis (CEA) is based on a multicentre randomised controlled trial encompassing 3,697 patients with hip replacement and 3,110 patients with knee replacement enrolled from 2019 to 2020 in 9 German hospitals. The analysis was conducted with a subset of 546 hip and 492 knee replacement cases with longitudinal cost data from 24 statutory health insurances. Patients were randomised 1:1 to a PROM-based remote monitoring and alert intervention or to a standard care group. All patients were assessed at 12-months post-surgery via digitally collected PROMs. Patients within the intervention group were additionally assessed at 1-, 3-, and 6-months post-surgery to be contacted in case of critical recovery paths. For the effect evaluation, a PROM-based composite measure (PRO-CM) was developed, combining changes across various PROMs in a single index ranging from 0 to 100. The PRO-CM included 6 PROMs focused on quality of life and various aspects of physical and mental health. The primary outcome was the incremental cost-effectiveness ratio (ICER). The intervention group showed incremental outcomes of 2.54 units PRO-CM (95% confidence interval (CI) [0.93, 4.14]; p = 0.002) for patients with hip and 0.87 (95% CI [-0.94, 2.67]; p = 0.347) for patients with knee replacement. Within the 12-months post-surgery period the intervention group had less costs of 376.43€ (95% CI [-639.74, -113.12]; p = 0.005) in patients with hip, and 375.50€ (95% CI [-767.40, 16.39]; p = 0.060) in patients with knee replacement, revealing a dominant ICER for both procedures. However, it remains unclear which step of the multistage intervention contributes most to the positive effect.

Conclusions: The intervention significantly improved patient outcomes at lower costs in patients with hip replacements when compared with standard care. Further it showed a nonsignificant cost reduction in knee replacement patients. This reinforces the notion that PROMs can be utilised as a cost-effective instrument for remote monitoring in standard care settings.

Trial registration: Registration: German Register for Clinical Studies (DRKS) under DRKS00019916.

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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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