Cost-effectiveness of multidisciplinary transitional care interventions: A systematic review and meta-analysis

IF 7.5 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2025-05-03 DOI:10.1016/j.ijnurstu.2025.105103

Romain Collet , Charlotte Groenewoud , Raymond Ostelo , Juul van Grootel , Marike van der Leeden , Marike van der Schaaf , Suzanne Wiertsema , Edwin Geleijn , Mel Major , Judith Bosmans , Johanna van Dongen

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引用次数: 0

Abstract

Background

Multidisciplinary transitional care interventions promote care coordination after hospital discharge and address (older) patients' complex care needs related to their physical, nutritional, and/or psychosocial status.

Objective

This review aimed to identify, critically appraise, and synthesize evidence on the cost-effectiveness of multidisciplinary transitional care interventions compared to usual care.

Design

Systematic review and meta-analysis.

Setting(s)

Hospitals and primary care.

Participants

Adult patients admitted to a hospital, regardless of their condition, and discharged home.

Methods

Medline, Embase, CINAHL, and CENTRAL were searched for randomized controlled trials assessing multidisciplinary transitional care interventions' cost-effectiveness compared to usual care and reporting quality of life or quality-adjusted life years (QALY) from inception to July 2024. Findings were stratified by economic perspective and follow-up duration. Evidence certainty was assessed using Grading of Recommendations Assessment, Development, and Evaluation. The primary outcome was the incremental net monetary benefit (expressed as mean difference). Cost-effectiveness acceptability curves depicted probabilities of cost-effectiveness at various willingness-to-pay thresholds.

Results

Thirteen trials, containing 4114 patients, were included. From a healthcare perspective over 12 months, there was “low” certainty that multidisciplinary transitional care interventions reduced healthcare costs (MD, €-3452; 95 % CI, − 8816 to 1912) while there was no difference in QALYs (MD, 0.00; 95 % CI, − 0.03 to 0.04) compared to usual care. The probability of cost-effectiveness over 12 months was 90 % at a willingness-to-pay of €0/QALY, decreasing slightly to 84 % at higher willingness-to-pay thresholds (“moderate” certainty). Over six months, cost-effectiveness probabilities ranged from 43 % at €0/QALY to 87 % at €100,000/QALY, exceeding 80 % at a willingness to pay of €50,000/QALY (“low” to “moderate” certainty). From a societal perspective, the probabilities of cost-effectiveness were lower, primarily due to a limited number of studies with conflicting results.

Conclusions

Multidisciplinary transitional care interventions demonstrate potential for cost-effectiveness. However, the “low” evidence certainty of most comparisons underscores the need for further research to explore the cost-effectiveness of different types of multidisciplinary transitional care interventions across patient populations and country income levels to identify the most cost-effective strategies.

Registration

The review protocol was registered on PROSPERO, CRD42023421423.

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多学科过渡性护理干预的成本效益：系统回顾和荟萃分析

多学科过渡护理干预促进出院后的护理协调，并解决（老年）患者与其身体、营养和/或社会心理状况相关的复杂护理需求。目的：本综述旨在识别、批判性评价和综合多学科过渡护理干预与常规护理相比的成本效益证据。设计：系统回顾和荟萃分析。背景：医院和初级保健。参与者：住院的成年患者，无论病情如何，出院回家。方法检索medline、Embase、CINAHL和CENTRAL的随机对照试验，评估多学科过渡护理干预与常规护理相比的成本效益，并报告从开始到2024年7月的生活质量或质量调整生命年（QALY）。研究结果按经济角度和随访时间进行分层。证据确定性采用推荐评估、发展和评价分级法进行评估。主要结果是增量净货币效益（以平均差异表示）。成本效益可接受性曲线描述了在不同支付意愿阈值下成本效益的概率。结果纳入13项试验，共4114例患者。从12个月的医疗保健角度来看，多学科过渡护理干预措施降低医疗保健成本的确定性“很低”(MD，€3452；95% CI， - 8816至1912)，而质量质量无差异(MD, 0.00；95% CI, - 0.03 ~ 0.04)。在支付意愿为0欧元/质量aly的情况下，12个月的成本效益概率为90%，在更高的支付意愿阈值（“中等”确定性）下，成本效益概率略微下降至84%。在6个月的时间里，成本效益概率从0欧元/QALY时的43%到10万欧元/QALY时的87%不等，而在愿意支付5万欧元/QALY时，成本效益概率超过80%（“低”到“中等”确定性）。从社会角度来看，成本效益的可能性较低，主要是由于研究数量有限，结果相互矛盾。结论多学科过渡性护理干预具有成本效益潜力。然而，大多数比较的“低”证据确定性强调需要进一步研究，以探索不同类型的多学科过渡护理干预措施在患者人群和国家收入水平中的成本效益，以确定最具成本效益的策略。注册：审查方案注册号为PROSPERO， CRD42023421423。

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

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).