Background

We compared the cost-effectiveness of 10 weeks of outreach rehabilitation (intervention) versus usual care (control) for ambulatory nursing home residents after hip fracture.

Methods

Enrollment occurred February 2011 through June 2015 in a Canadian metropolitan region. 77 participants were allocated in a 2:1 ratio to receive a 10-week rehabilitation program (intervention) or usual care (control) (46 intervention; 31 control). Using a payer perspective, we performed main and sensitivity analyses. Health outcome was measured by quality-adjusted life years(QALYs), using the EQ5D, completed at study entry, 3-, 6-, and 12-months. We obtained patient-specific data for outpatient visits, physician claims, and inpatient re-admissions; the trial provided rehabilitation utilization/cost data. We estimated incremental cost and incremental effectiveness.

Results

Groups were similar at study entry; the mean age was 87.9±6.6 years, 54(71%) were female and 58(75%) had severe cognitive impairment. EQ5D QALYs scores were non-significantly higher for intervention participants. Inpatient re-admissions were two times higher among controls, with a cost difference of -$3350/patient for intervention participants, offsetting the cost/intervention participant of $2300 for the outreach rehabilitation. The adjusted incremental QALYs/patient difference was 0.024 favouring the intervention, with an incremental cost/patient of -$621 for intervention participants; these values were not statistically significant. A sensitivity analysis reinforced these findings, suggesting that the intervention was likely dominant.

Conclusion

A 10-week outreach rehabilitation intervention for nursing home residents who sustain a hip fracture may be cost-saving, through reduced post-fracture hospital re-admissions. These results support further work to evaluate post-fracture rehabilitation for nursing home residents.

中文翻译：

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针对髋部骨折后的疗养院居民的外展康复计划可能会节省成本。

背景

我们比较了髋部骨折后门诊疗养院居民进行10周外展康复（干预）与常规护理（对照）的成本效益。

方法

招生发生在2011年2月至2015年6月的加拿大大都市地区。按2：1的比例分配了77名参与者，以接受为期10周的康复计划（干预）或常规护理（对照）（46干预； 31对照）。从付款人角度出发，我们进行了主要和敏感性分析。使用EQ5D通过质量调整生命年（QALYs）来衡量健康结局，该研究在研究进入，3、6和12个月时完成。我们获得了针对患者的数据，包括门诊就诊，医生索赔和住院再住院的数据。该试验提供了康复利用/费用数据。我们估算了增加的成本和增加的有效性。

结果

研究入组的人群相似。平均年龄为87.9±6.6岁，其中54例（71％）为女性，58例（75％）为严重认知障碍。干预参与者的EQ5D QALYs分数明显不高。与对照组相比，住院患者的再住院率高出两倍，干预参与者的每位患者费用差额为-3350美元，抵消了外展康复服务的2300美元的费用/干预额。调整后的增量QALY /患者差异为0.024，有利于干预，干预参与者的成本/患者增量为-$ 621；这些值没有统计学意义。敏感性分析加强了这些发现，表明该干预可能占主导地位。

结论

通过减少骨折后的医院再次入院，对患有髋部骨折的疗养院居民进行为期10周的外展康复干预可能会节省成本。这些结果为评估疗养院居民骨折后康复的进一步工作提供了支持。