哮喘联盟

   摘要
   目的：研究波士顿儿童医院社区哮喘倡议（CAI）项目在降低急诊（ED）和住院、提升患者及家庭成员的生活质量（降低缺课天数和缺勤天数）中的成本与收益
   方法：采用成本-效益分析，对无CAI干预的对照人群变化进行校正后，于2006年在参与CAI项目的102名患者中确定校正后的投资回报率(ROI)。通过纳入因缺课天数和缺勤天数下降导致的额外间接收益来计算社会投资回报率(SROI)。
   结果：对除CAI干预之外其他因素校正后，前3年内因ED就诊和住院下降导致的校正后费用节省，引起校正后的ROI为1.33（节省费用校正后的净现值[NPV] = $83 863）。将缺课天数和缺勤天数下降带来的收益加入校正后的节省费用后，SROI增加至1.85（节省费用的社会NPV= $215 100）。
   结论：多学科、协调疾病管理项目为预防慢性疾病高开支的并发症和住院提供了机会，同时改善了患者及其家庭成员的生活质量。成本分析支持基于社区的积极哮喘服务，而这些服务过去在医疗系统范围内是不予报销的。

（苏楠 审校）
J Asthma. 2013 Jan 11. [Epub ahead of print]

 

A Cost Analysis for a Community-Based Case Management Intervention Program for Pediatric Asthma.
 
Bhaumik U, Norris K, Charron G, Walker SP, Sommer SJ, Chan E, Dickerson DU, Nethersole S,Woods ER.

Source
1Office of Child Advocacy, Boston Children's.

Abstract 
OBJECTIVE: Evaluate the costs and benefits of the Boston Children's Hospital Community Asthma Initiative (CAI) program through reduction of Emergency Department (ED) visits and hospitalizations and quality of life for patients and their families due to reduced missed school days and work days.
METHODS: Cost-benefit analysis was used to determine an adjusted Return on Investment (ROI) for all 102 patients enrolled in the CAI program in the calendar year 2006 after controlling for changes in a comparable population without CAI intervention. A societal ROI (SROI) was also computed by including additional indirect benefits due to reduced missed school days for patients and work days for caregivers.
RESULTS: Adjusted cost savings from fewer ED visits and hospitalizations resulted in an adjusted ROI of 1.33 (adjusted Net Present Value, (NPV) of savings = $83 863) during the first 3 years after controlling for factors other than the CAI intervention. When benefits due to reduced missed school days and missed work days were added to adjusted cost savings, the SROI increased to 1.85 (Societal NPV of savings = $215 100).
CONCLUSIONS: Multidisciplinary, coordinated disease management programs offer the opportunity to prevent costly complications and hospitalizations for chronic diseases, while improving quality of life for patients and families. This cost analysis supports the business case for the provision of proactive community-based asthma services that are traditionally not reimbursed by the fee-for-service health care system.

J Asthma. 2013 Jan 11. [Epub ahead of print]