与标准治疗相比,远程医疗在治疗2型糖尿病方面具有成本效益——一项门诊的随机试验和经济分析

Ole Winther Rasmussen, F. Lauszus, M. Løkke, M. Jensen
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引用次数: 1

摘要

背景:门诊控制需要新的方法,需要试验来激励和反馈在家的病人。远程医疗有能力实现这一目标,通过适应患者环境的激励和直接反馈来优化护理,同时将总成本保持在合理的水平。目的:评估2型糖尿病(T2DM)患者两种不同门诊治疗方式的经济和短期健康效果。一位卫生经济学家计算了用远程医疗取代标准医疗的总成本。方法:将40例门诊T2DM患者前瞻性随机分为两组,一组在家中进行远程医疗视频会议治疗,另一组在6个月内定期到诊所就诊。审判持续了六个月。糖化血红蛋白、bloodglucose 24-hbloodpressure cholesterollevelsandalbuminuriaweremeasured。丹麦电话公司TDC为远程医疗组的患者提供了一台TandBerg E20视频电话。经济分析是用丹麦医院付款人的成本角度进行的。成本数据基于每部家庭视频电话的测量时间消耗、门诊咨询、远程医疗设置设备和医院运营成本。经样本量计算,每组需要11例患者。结果:Thereductionsinthetwotreatmentsresultedindifferencesbetweentelemedicinevs。标准,糖化血红蛋白(9.1 - 7.7% vs. 8.1 - 7.2%),平均血糖(12 - 9.9mmol/ lvs .10 - 8.7mmol/L),胆固醇(3.8 - 3.4vs.)。4.3 to3.9mmol / L)。两组总胆固醇在3个月和6个月时差异有统计学意义(P < 0.05)。两组在所有时间点LDL、体重和日血压的值相似。在6个月的随访中,标准治疗证明成本更高(HbA1c每降低1%,标准治疗与远程医疗分别为53.9欧元和41.3欧元)。从任何起点计算基础病例显示,糖化血红蛋白每降低1%,潜在的额外成本为33.6欧元。另一种方案分析是为了获取使用医生咨询服务而不是在门诊诊所进行护理的成本,结果表明,即使更换人员,仍有可能节省成本(每降低HbA1c %,医生与护士的对比为49.4欧元,而不是41.3欧元)。结论:我们证明了药物治疗t2dm是一种成本有效的选择,治疗6个月后血糖改善,成本更低。这一试验的背景要求在这一领域开展进一步的项目。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Telemedicine is Cost Effective Compared with Standard Care in Type 2 Diabetes Mellitus - A Randomized Trial with an Economic Analysis in an Outpatient Clinic
Background: New approaches on outpatient control are required and need testing to motivate and give feedback to the patients at home. Telemedicine has the capacity to achieve this, optimizing care through motivation and direct feedback adapted to milieu of the patient and at the same time to keep the total cost at a reasonable level. Objectives: We evaluated the economic and short-time health effect of two different ways of outpatient treatment in patients with type 2 diabetes (T2DM). A health economist calculated the total cost of replacing the standard care with telemedicine. Methods: Forty patients with T2DM in the outpatient department were prospectively randomized to either treatment at home by telemedicine with video conferences or the standard treatment with regular visits at the clinic over six months. The trial lasted for sixmonths. HbA1c,bloodglucose,24-hbloodpressure,cholesterollevelsandalbuminuriaweremeasured. Thetelephonecompany, TDC, Denmark delivered and serviced a TandBerg E20 video telephone to the patients in the telemedicine group. The economic analysis was performed with a Danish hospital payer’s cost perspective. Cost data were based on the measured time consumption per home-based video telephone, consultations at out-patient clinic, telemedicine set-up equipment, and hospital operating cost. Sample size calculation concluded that 11 patients were needed in each group. Results: Thereductionsinthetwotreatmentsresultedindifferencesbetweentelemedicinevs. standard,inHbA1c(9.1to7.7% vs. 8.1 to7.2%),meanbloodglucose(12to9.9mmol/Lvs.10to8.7mmol/L),andcholesterol(3.8to3.4vs. 4.3to3.9mmol/L).Totalcholesterol was different at three and at six months between the two groups (P < 0.05). Similar values were found at all time points in the two groups in LDL, body weight, and diurnal blood pressure. At a six months follow-up, the standard care proved more costly (53.9 vs. 41.3€ per 1 % HbA1c reduction, standard care vs. telemedicine). The calculation of a basis case from any starting point showed a potential extra cost €33.6 per reduction of 1 % HbA1c. An alternative scenario analysis was made to capture costs of using the physicianconsultantwageinsteadof thenurseattheoutpatientclinicandshowedthatsavingswerestillpossibleevenwithchange of person (49.4 instead of 41.3€ per reduction per % HbA1c, physician vs. nurse). Conclusions: Wedemonstratedthattelemedicineisacost-effectiveoptioninthetreatmentof T2DMwithabetteroutcomeinblood glucose and lower cost after six months of treatment. The setting of this trial warrants further projects in this field.
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