日本老年痴呆患者管饲的成本-效果分析：净收益回归方法

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics Pub Date : 2025-03-04 DOI:10.1016/j.archger.2025.105812

Ning Liu , Akira Babazono , Kenshi Hayashida , Aziz Jamal , Reiko Ishihara , Reiko Yamao , Shinichiro Yoshida , Shinya Matsuda , Yunfei Li

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引用次数: 0

摘要

本研究旨在评估与非人工营养相比，经皮内镜胃造口术（PEG）和鼻胃管（NGT）治疗老年晚期痴呆患者的成本效益。方法回顾性队列研究。研究使用了日本福冈县的医疗索赔数据和长期护理索赔数据。我们确定了2016年4月至2019年3月期间因吞咽困难、营养不良或吸入性肺炎住院的3882名老年痴呆症患者（≥75岁）。通过倾向评分匹配，我们将PEG组的192例患者与非人工营养组的192例患者进行了匹配，NGT组的490例患者与非人工营养组的490例患者进行了匹配。我们检查了每位患者从入院之日到2020年3月31日的生存年限和总成本，从而分别估计了PEG和NGT与非人工营养相比的成本效益。采用净效益回归模型对不同支付意愿（WTP）值下PEG和NGT的增量净效益（INB）进行估算。此外，使用成本-效果可接受度曲线来表示每种干预措施的成本-效果概率。结果随着WTP从7,747,909日元（相当于51,546美元）增加到28,163,651日元（相当于187,371美元），PEG具有成本效益的可能性从50%增加到接近100%。NGT组的INB值为负。结论PEG和NGT对晚期痴呆患者的经济价值均较低。但是，这一结论还需要从多个角度进行详细的成本效益分析来进一步完善。

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Cost-effectiveness analysis of tube feeding among older adults with advanced dementia in Japan: A net benefit regression approach

Background

This study aims to assess the cost-effectiveness of percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) in older adults with advanced dementia, compared with non-artificial nutrition.

Methods

Retrospective cohort study. Medical claims data and long-term care claims data from Fukuoka Prefecture, Japan, were used. We identified 3,882 older adults (≥75 years) with advanced dementia who were hospitalized between April 2016 and March 2019 due to dysphagia, malnutrition, or aspiration pneumonia. Using propensity score matching, we matched 192 patients in the PEG group with 192 in the non-artificial nutrition group, and 490 patients in the NGT group with 490 in the non-artificial nutrition group. We examined the survival years and total costs of each patient from the date of admission to March 31, 2020, and thereby estimated the cost-effectiveness of PEG and NGT, respectively, versus non-artificial nutrition. The net benefit regression model was employed to estimate the incremental net benefits (INB) with varying values of willingness-to-pay (WTP) for PEG and NGT. Furthermore, cost-effectiveness acceptability curve was used to present the probability of the cost-effectiveness of each intervention.

Results

As WTP increased from JPY 7,747,909 (equivalent to US$51,546) to JPY 28,163,651 (equivalent to US$187,371), the probability of PEG being cost-effective increased from 50 % to nearly100 %. The NGT group had negative INB estimates.

Conclusions

Both PEG and NGT are less likely to provide economic values for patients with advanced dementia. However, this conclusion should be further refined through detailed cost-effectiveness analysis from multiple perspectives.

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来源期刊

Archives of gerontology and geriatrics 医学-老年医学

CiteScore

7.30

自引率

5.00%

发文量

198

审稿时长

16 days

期刊介绍： Archives of Gerontology and Geriatrics provides a medium for the publication of papers from the fields of experimental gerontology and clinical and social geriatrics. The principal aim of the journal is to facilitate the exchange of information between specialists in these three fields of gerontological research. Experimental papers dealing with the basic mechanisms of aging at molecular, cellular, tissue or organ levels will be published. Clinical papers will be accepted if they provide sufficiently new information or are of fundamental importance for the knowledge of human aging. Purely descriptive clinical papers will be accepted only if the results permit further interpretation. Papers dealing with anti-aging pharmacological preparations in humans are welcome. Papers on the social aspects of geriatrics will be accepted if they are of general interest regarding the epidemiology of aging and the efficiency and working methods of the social organizations for the health care of the elderly.