Hongpeng Liu1, Dawei Zhu2, Baoyun Song3, Jingfen Jin4, Yilan Liu5, Xianxiu Wen6, Shouzhen Cheng7, Stephen Nicholas8, Xinjuan Wu9. 1. Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China. Electronic address: liuhongpeng12@sina.com. 2. China Center for Health Development Studies, Peking University, No.38, Xueyuan Road, Haidian District, Beijing 100191, China. Electronic address: zhu_dawei@163.com. 3. Department of Nursing, Henan Provincial People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou 450003, China. Electronic address: baoyun8865@126.com. 4. Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou 310009, China. Electronic address: zrjzkhl@zju.edu.cn. 5. Department of Nursing, Wuhan Union Hospital, No.1277 Jiefangdadao, Jianghan District, Wuhan 430060, China. Electronic address: yilanl2008@sina.com. 6. Department of Nursing, Sichuan Provincial People's Hospital, No.32 West Second Section First Ring Road, Chengdu 610072, China. Electronic address: wxxjyc@163.com. 7. Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Second Road, Yuexiu District, Guangzhou 200032, China. Electronic address: szcheng05@126.com. 8. Australian National Institute of Management and Commerce, 1 Central Avenue Australian Technology Park, Eveleigh Sydney NSW 2015, Australia; School of Economics and School of Management, Tianjin Normal University, West Bin Shui Avenue, Tianjin 300074, China; Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun Avenue North, Guangzhou 510420, China; Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2308, Australia. Electronic address: stephen.nicholas@newcastle.edu.au. 9. Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China. Electronic address: wuxinjuan@sina.com.
Abstract
BACKGROUND: While a nursing intervention program for immobile patients with stroke can improve clinic outcomes, less is known about the cost-effectiveness of these interventions. OBJECTIVES: The goal of this study was to evaluate the cost-effectiveness of the intervention program for immobile patients with stroke in China. DESIGN: A cost-effectiveness analysis alongside a pre-test/post-test (before and after) study was undertaken from a health care perspective. SETTINGS: Participants were recruited from 25 hospitals among six provinces or municipal cities in eastern (Guangdong province, Zhejiang province, and Beijing municipal city), western (Sichuan province), and central (Henan province and Hubei province) China. PARTICIPANTS: A total of 7,653 immobile stroke patients were included in our sample. Patients in routine care settings were recruited from November 2015 to June 2016, and the recruitment of the intervention group patients was from November 2016 to July 2017. METHODS: To adjust for potential bias from confounding variables, the 1:1 propensity score matching yielded matched pairs of 2,966 patients in the routine care group and 2,966 patients in the intervention group, with no significant differences in sociodemographic or clinical characteristics between two groups. All patients were followed-up 3 months after enrolment in the study. Total healthcare costs were extracted from the hospital information system, with the health outcome effectiveness of the intervention program measured using the EuroQol five-dimensional questionnaire (EQ-5D) instrument and the cost-effectiveness of the intervention measured by the incremental cost-effectiveness ratio with a time horizon of 3 months. RESULTS: Compared to routine care, the intervention program decreased the total costs of stroke patients by CN¥4,600 (95% confidence interval [CI]: [-7050, -2151]), while increasing quality-adjusted life year 0.009 (95% CI: [0.005, 0.013]). The incremental cost-effectiveness ratios over 3 months was CN¥-517,011 per quality-adjusted life year (95% CI: [-1,111,442, -203,912]). Subgroup analysis reveals that both the health-related quality of life and cost effectiveness improved significantly for ischemic patients and tertiary hospitals patients while for hemorrhagic patients and non-tertiary hospital patients only the health-related quality of life improved significantly. CONCLUSIONS: Findings from this first cost-effectiveness analysis in immobile stroke patients provide evidence that an intervention program provided significant cost saving, but mainly in ischemic patients and tertiary hospital patients. Wider adoption of such programs may be a sensible approach to reducing the burden of stroke and for immobile patients more generally.
BACKGROUND: While a nursing intervention program for immobile patients with stroke can improve clinic outcomes, less is known about the cost-effectiveness of these interventions. OBJECTIVES: The goal of this study was to evaluate the cost-effectiveness of the intervention program for immobile patients with stroke in China. DESIGN: A cost-effectiveness analysis alongside a pre-test/post-test (before and after) study was undertaken from a health care perspective. SETTINGS: Participants were recruited from 25 hospitals among six provinces or municipal cities in eastern (Guangdong province, Zhejiang province, and Beijing municipal city), western (Sichuan province), and central (Henan province and Hubei province) China. PARTICIPANTS: A total of 7,653 immobile strokepatients were included in our sample. Patients in routine care settings were recruited from November 2015 to June 2016, and the recruitment of the intervention group patients was from November 2016 to July 2017. METHODS: To adjust for potential bias from confounding variables, the 1:1 propensity score matching yielded matched pairs of 2,966 patients in the routine care group and 2,966 patients in the intervention group, with no significant differences in sociodemographic or clinical characteristics between two groups. All patients were followed-up 3 months after enrolment in the study. Total healthcare costs were extracted from the hospital information system, with the health outcome effectiveness of the intervention program measured using the EuroQol five-dimensional questionnaire (EQ-5D) instrument and the cost-effectiveness of the intervention measured by the incremental cost-effectiveness ratio with a time horizon of 3 months. RESULTS: Compared to routine care, the intervention program decreased the total costs of strokepatients by CN¥4,600 (95% confidence interval [CI]: [-7050, -2151]), while increasing quality-adjusted life year 0.009 (95% CI: [0.005, 0.013]). The incremental cost-effectiveness ratios over 3 months was CN¥-517,011 per quality-adjusted life year (95% CI: [-1,111,442, -203,912]). Subgroup analysis reveals that both the health-related quality of life and cost effectiveness improved significantly for ischemicpatients and tertiary hospitals patients while for hemorrhagicpatients and non-tertiary hospital patients only the health-related quality of life improved significantly. CONCLUSIONS: Findings from this first cost-effectiveness analysis in immobile strokepatients provide evidence that an intervention program provided significant cost saving, but mainly in ischemicpatients and tertiary hospital patients. Wider adoption of such programs may be a sensible approach to reducing the burden of stroke and for immobile patients more generally.
Authors: Yong Yang; Stephen Nicholas; Elizabeth Maitland; Zhengwei Huang; Xiaoping Chen; Yong Ma; Xuefeng Shi Journal: BMC Health Serv Res Date: 2021-05-05 Impact factor: 2.655