Cost-utility analysis of a coadjutant telemedicine intervention for fall prevention in Parkinson's disease

IF 4.5 2区医学 Q1 CLINICAL NEUROLOGY

European Journal of Neurology Pub Date : 2025-01-21 DOI:10.1111/ene.16561

Esther Cubo, Mohammad Rohani, Negin Eissazade, Álvaro Garcia-Bustillo, José Miguel Ramírez-Sanz, José Luis Garrido-Labrador, Alicia Olivares-Gil, Florita Valiñas-Sieiro Rn, Marta Allende-Río Rn, Josefa Gonzalez-Santos, Jerónimo Javier Gonzalez-Bernal, José Trejo, Sara Calvo-Simal, José Francisco Diez-Pastor, David García-García, Álvar Arnaiz-González

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Abstract

Background and purpose

Adopting telemedicine (TM) enables improved access to specialized care and reduces barriers. The aim was to assess the cost-utility of a coadjutant multidisciplinary TM programme for fall prevention compared to standard in-office visits for individuals with Parkinson's disease (PD).

Methods

This was an 8-month single-blind randomized controlled trial. TM and control groups received in-office visits and standard management care at baseline, 4 and 8 months. In addition, the TM group received remote multidisciplinary visits for 4 months. Gait, motor and non-motor symptoms, daily living activities, balance and frailty were measured using PD-recommended rating scales and wearable sensors. Clinical characteristics were compared at each visit using baseline scores, gender and age as covariates. The incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs) were calculated at each visit.

Results

Fifty patients were included: 25 patients in the TM group (48% males, mean age 71.1 ± 9.0 years) and 25 patients in the control group (52% males, mean age 69.2 ± 9.4 years). Compared to controls, in the TM group similar QALYs were found but, in contrast, significant improvements in daily living activities, depression, apathy, freezing of gait, balance, quality of life and frailty (all p values <0.05). The use of coadjutant TM intervention in addition to in-office visits was efficient for depression, apathy, freezing of gait, balance and frailty with ICERs, ranging from 91.55 € for non-motor symptoms to 1677.4 € for frailty.

Conclusions

Telemedicine could be considered an efficient coadjutant intervention for PD, especially for non-motor symptoms, enhancing health outcomes and accessibility.

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辅助远程医疗干预预防帕金森病跌倒的成本-效用分析

背景和目的：采用远程医疗可以改善获得专业护理的机会并减少障碍。目的是评估与帕金森病患者（PD）标准门诊就诊相比，辅助多学科TM计划预防跌倒的成本-效用。方法：8个月的单盲随机对照试验。TM组和对照组分别在基线、4个月和8个月接受办公室就诊和标准管理护理。此外，TM组接受4个月的多学科远程访视。采用pd推荐评定量表和可穿戴传感器测量步态、运动和非运动症状、日常生活活动、平衡和虚弱。临床特征在每次就诊时进行比较，使用基线评分、性别和年龄作为协变量。每次就诊时计算增量成本-效果比（ICER）和质量调整生命年（QALYs）。结果：纳入50例患者：TM组25例（男性48%，平均年龄71.1±9.0岁），对照组25例（男性52%，平均年龄69.2±9.4岁）。与对照组相比，在TM组中发现相似的QALYs，但相反，在日常生活活动，抑郁，冷漠，步态冻结，平衡，生活质量和虚弱方面有显着改善（均p值）。结论：远程医疗可以被认为是PD的有效辅助干预，特别是对非运动症状，提高健康结局和可及性。

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

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).