{"title":"预防心脏瓣膜手术后肺部并发症的三天康复计划具有成本效益：一项随机试验的卫生经济学分析。","authors":"Wei Huang, Yuqiang Wang, Zeruxin Luo, Xiu Zhang, Mengxuan Yang, Jianhua Su, Yingqiang Guo, Pengming Yu","doi":"10.31083/j.rcm2509323","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>While prehabilitation (pre surgical exercise) effectively prevents postoperative pulmonary complications (PPCs), its cost-effectiveness in valve heart disease (VHD) remains unexplored. This study aims to evaluate the cost-effectiveness of a three-day prehabilitation program for reducing PPCs and improving quality adjusted life years (QALYs) in Chinese VHD patients.</p><p><strong>Methods: </strong>A cost-effectiveness analysis was conducted alongside a randomized controlled trial featuring concealed allocation, blinded evaluators, and an intention-to-treat analysis. In total, 165 patients scheduled for elective heart valve surgery at West China Hospital were randomized into intervention and control groups. The intervention group participated in a three-day prehabilitation exercise program supervised by a physiotherapist while the control group received only standard preoperative education. Postoperative hospital costs were audited through the Hospital Information System, and the EuroQol five-dimensional questionnaire was used to provide a 12-month estimation of QALY. Cost and effect differences were calculated through the bootstrapping method, with results presented in cost-effectiveness planes, alongside the associated cost-effectiveness acceptability curve (CEAC). All costs were denominated in Chinese Yuan (CNY) at an average exchange rate of 6.73 CNY per US dollar in 2022.</p><p><strong>Results: </strong>There were no statistically significant differences in postoperative hospital costs (8484 versus 9615 CNY, 95% CI -2403 to 140) or in the estimated QALYs (0.909 versus 0.898, 95% CI -0.013 to 0.034) between the intervention and control groups. However, costs for antibiotics (339 versus 667 CNY, 95% CI -605 to -51), nursing (1021 versus 1200 CNY, 95% CI -330 to -28), and electrocardiograph monitoring (685 versus 929 CNY, 95% CI -421 to -67) were significantly lower in the intervention group than in the control group. The CEAC indicated that the prehabilitation program has a 92.6% and 93% probability of being cost-effective in preventing PPCs and improving QALYs without incurring additional costs.</p><p><strong>Conclusions: </strong>While the three-day prehabilitation program did not significantly improve health-related quality of life, it led to a reduction in postoperative hospital resource utilization. Furthermore, it showed a high probability of being cost-effective in both preventing PPCs and improving QALYs in Chinese patients undergoing valve surgery.</p><p><strong>Clinical registration number: </strong>This trial is registered in the Chinese Clinical Trial Registry (URL: https://www.chictr.org.cn/) with the registration identifier ChiCTR2000039671.</p>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440420/pdf/","citationCount":"0","resultStr":"{\"title\":\"A Three-Day Prehabilitation Program is Cost-Effective for Preventing Pulmonary Complications after Heart Valve Surgery: A Health Economic Analysis of a Randomized Trial.\",\"authors\":\"Wei Huang, Yuqiang Wang, Zeruxin Luo, Xiu Zhang, Mengxuan Yang, Jianhua Su, Yingqiang Guo, Pengming Yu\",\"doi\":\"10.31083/j.rcm2509323\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>While prehabilitation (pre surgical exercise) effectively prevents postoperative pulmonary complications (PPCs), its cost-effectiveness in valve heart disease (VHD) remains unexplored. This study aims to evaluate the cost-effectiveness of a three-day prehabilitation program for reducing PPCs and improving quality adjusted life years (QALYs) in Chinese VHD patients.</p><p><strong>Methods: </strong>A cost-effectiveness analysis was conducted alongside a randomized controlled trial featuring concealed allocation, blinded evaluators, and an intention-to-treat analysis. In total, 165 patients scheduled for elective heart valve surgery at West China Hospital were randomized into intervention and control groups. The intervention group participated in a three-day prehabilitation exercise program supervised by a physiotherapist while the control group received only standard preoperative education. Postoperative hospital costs were audited through the Hospital Information System, and the EuroQol five-dimensional questionnaire was used to provide a 12-month estimation of QALY. Cost and effect differences were calculated through the bootstrapping method, with results presented in cost-effectiveness planes, alongside the associated cost-effectiveness acceptability curve (CEAC). All costs were denominated in Chinese Yuan (CNY) at an average exchange rate of 6.73 CNY per US dollar in 2022.</p><p><strong>Results: </strong>There were no statistically significant differences in postoperative hospital costs (8484 versus 9615 CNY, 95% CI -2403 to 140) or in the estimated QALYs (0.909 versus 0.898, 95% CI -0.013 to 0.034) between the intervention and control groups. However, costs for antibiotics (339 versus 667 CNY, 95% CI -605 to -51), nursing (1021 versus 1200 CNY, 95% CI -330 to -28), and electrocardiograph monitoring (685 versus 929 CNY, 95% CI -421 to -67) were significantly lower in the intervention group than in the control group. 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引用次数: 0
摘要
背景：虽然术前康复（术前运动）可有效预防术后肺部并发症（PPCs），但其在瓣膜性心脏病（VHD）中的成本效益仍有待探索。本研究旨在评估为期三天的术前康复计划在减少中国瓣膜病患者肺部并发症和提高质量调整生命年（QALYs）方面的成本效益：方法：在进行随机对照试验的同时，还进行了成本效益分析，该试验采用了隐蔽分配、评估者盲法和意向治疗分析法。共有 165 名计划在华西医院接受心脏瓣膜手术的患者被随机分为干预组和对照组。干预组参加由理疗师指导的为期三天的术前康复锻炼计划，而对照组只接受标准的术前教育。通过医院信息系统对术后住院费用进行了审计，并使用EuroQol五维问卷估算了12个月的QALY。成本和效果差异通过引导法计算，结果以成本效益平面和相关的成本效益可接受性曲线（CEAC）表示。所有成本均以 2022 年 1 美元兑 6.73 元人民币的平均汇率计算：干预组和对照组的术后住院费用（8484 对 9615 人民币，95% CI -2403 至 140）或估计 QALYs（0.909 对 0.898，95% CI -0.013 至 0.034）在统计学上无显著差异。然而，干预组的抗生素费用（339 对 667 元人民币，95% CI -605-51）、护理费用（1021 对 1200 元人民币，95% CI -330-28）和心电图监测费用（685 对 929 元人民币，95% CI -421-67）显著低于对照组。CEAC指出，在不产生额外费用的情况下，预康复计划在预防PPC和改善QALY方面的成本效益概率分别为92.6%和93%：虽然为期三天的术前康复计划并未显著改善与健康相关的生活质量，但却减少了术后医院资源的使用。此外，对于接受瓣膜手术的中国患者来说，该方案在预防 PPCs 和改善 QALYs 方面都很有可能具有成本效益：本试验已在中国临床试验注册中心（URL：https://www.chictr.org.cn/）注册，注册编号为ChiCTR2000039671。
A Three-Day Prehabilitation Program is Cost-Effective for Preventing Pulmonary Complications after Heart Valve Surgery: A Health Economic Analysis of a Randomized Trial.
Background: While prehabilitation (pre surgical exercise) effectively prevents postoperative pulmonary complications (PPCs), its cost-effectiveness in valve heart disease (VHD) remains unexplored. This study aims to evaluate the cost-effectiveness of a three-day prehabilitation program for reducing PPCs and improving quality adjusted life years (QALYs) in Chinese VHD patients.
Methods: A cost-effectiveness analysis was conducted alongside a randomized controlled trial featuring concealed allocation, blinded evaluators, and an intention-to-treat analysis. In total, 165 patients scheduled for elective heart valve surgery at West China Hospital were randomized into intervention and control groups. The intervention group participated in a three-day prehabilitation exercise program supervised by a physiotherapist while the control group received only standard preoperative education. Postoperative hospital costs were audited through the Hospital Information System, and the EuroQol five-dimensional questionnaire was used to provide a 12-month estimation of QALY. Cost and effect differences were calculated through the bootstrapping method, with results presented in cost-effectiveness planes, alongside the associated cost-effectiveness acceptability curve (CEAC). All costs were denominated in Chinese Yuan (CNY) at an average exchange rate of 6.73 CNY per US dollar in 2022.
Results: There were no statistically significant differences in postoperative hospital costs (8484 versus 9615 CNY, 95% CI -2403 to 140) or in the estimated QALYs (0.909 versus 0.898, 95% CI -0.013 to 0.034) between the intervention and control groups. However, costs for antibiotics (339 versus 667 CNY, 95% CI -605 to -51), nursing (1021 versus 1200 CNY, 95% CI -330 to -28), and electrocardiograph monitoring (685 versus 929 CNY, 95% CI -421 to -67) were significantly lower in the intervention group than in the control group. The CEAC indicated that the prehabilitation program has a 92.6% and 93% probability of being cost-effective in preventing PPCs and improving QALYs without incurring additional costs.
Conclusions: While the three-day prehabilitation program did not significantly improve health-related quality of life, it led to a reduction in postoperative hospital resource utilization. Furthermore, it showed a high probability of being cost-effective in both preventing PPCs and improving QALYs in Chinese patients undergoing valve surgery.
Clinical registration number: This trial is registered in the Chinese Clinical Trial Registry (URL: https://www.chictr.org.cn/) with the registration identifier ChiCTR2000039671.
期刊介绍：
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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