Real-World Cost-Consequence Analysis of an Integrated Chronic Disease Management Program in Saskatchewan, Canada

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES
J. P. Kuwornu, Fernando Maldonado, Gary Groot, E. Penz, Elizabeth J Cooper, Amy Reid, Darcy D Marciniuk
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Abstract

An integrated disease management program otherwise called a clinical pathway was recently implemented in Saskatchewan, Canada for patients living with chronic obstructive pulmonary disease (COPD). This study compared the real-world costs and consequences of the COPD clinical pathway program with 2 control treatment programs. The study comprised adult COPD patients in Regina (clinical pathway group, N = 759) matched on propensity scores to 2 independent control groups of similar adults in (1) Regina (historical controls, N = 759) and (2) Saskatoon (contemporaneous controls, N = 759). The study measures included patient-level healthcare costs and acute COPD exacerbation outcomes, both tracked in population-based administrative health data over a one-year follow-up period. Analyses included Cox proportional hazards models and differences in means between groups. The bias-corrected and accelerated bootstrap method was used to calculate 95% confidence intervals (CI). The COPD pathway patients had lower risks of moderate (hazard ratio [HR] =0.57, 95% CI [0.40-0.83]) and severe (HR = 0.43, 95% CI [0.28-0.66]) exacerbations compared to the historical control group, but similar risks compared with the contemporaneous control group. The COPD pathway patients experienced fewer episodes of exacerbations compared with the historical control group (mean difference = −0.30, 95% CI [−0.40, −0.20]) and the contemporaneous control group (mean difference = −0.12, 95% CI [−0.20, −0.03]). Average annual healthcare costs in Canadian dollars were marginally higher among patients in the COPD clinical pathway (mean = $10 549, standard deviation [SD] =$18 149) than those in the contemporaneous control group ($8841, SD = $17 120), but comparable to the historical control group ($10 677, SD = $21 201). The COPD pathway provides better outcomes at about the same costs when compared to the historical controls, but only slightly better outcomes and at a marginally higher cost when compared to the contemporaneous controls.
加拿大萨斯喀彻温省慢性病综合管理计划的实际成本-后果分析
最近,加拿大萨斯喀彻温省为慢性阻塞性肺病(COPD)患者实施了一项被称为临床路径的综合疾病管理计划。这项研究比较了慢性阻塞性肺病临床路径项目与两个对照治疗项目的实际成本和后果。研究对象包括里贾纳的慢性阻塞性肺病(COPD)成年患者(临床路径组,N = 759),他们与里贾纳(历史对照组,N = 759)和萨斯卡通(当代对照组,N = 759)的两个类似成年患者独立对照组的倾向得分相匹配。研究指标包括患者的医疗费用和慢性阻塞性肺疾病急性加重的结果,这两项指标都在一年的随访期内通过基于人口的行政健康数据进行跟踪。分析包括 Cox 比例危险模型和组间均值差异。采用偏差校正和加速引导法计算95%置信区间(CI)。与历史对照组相比,慢性阻塞性肺病路径患者的中度(危险比 [HR] =0.57,95% CI [0.40-0.83])和重度(HR = 0.43,95% CI [0.28-0.66])病情加重风险较低,但与同期对照组相比风险相似。与历史对照组(平均差异=-0.30,95% CI [-0.40,-0.20])和同期对照组(平均差异=-0.12,95% CI [-0.20,-0.03])相比,慢性阻塞性肺病路径患者的病情加重次数更少。以加元计算,慢性阻塞性肺病临床路径患者的年均医疗费用(平均值=10 549加元,标准差=18 149加元)略高于同期对照组(8841加元,标准差=17 120加元),但与历史对照组(10 677加元,标准差=21 201加元)相当。与历史对照组相比,慢性阻塞性肺病路径提供了更好的治疗效果,费用基本相同,但与同期对照组相比,治疗效果略好,费用略高。
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
Health Services Insights
Health Services Insights HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.60
自引率
0.00%
发文量
47
审稿时长
8 weeks
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