Purpose

The occurrence of adverse events (AE) in hospitalized patients substancially increases the risk of disability or death, having a major negative clinical and economic impact on public health. For early identification of patients at risk and to establish preventive measures, different healthcare systems have implemented rapid response systems (RRS). The aim of this study was to carry out a cost-effectiveness analysis of implementing a RRS in a tertiary-care hospital.

Methods

We included all the patients admitted to Hospital Clínic de Barcelona from 1 to 2016 to 31 December 2016. The cost-effectiveness analysis was summarized as the incremental cost-effectiveness ratio (incremental cost divided by the incremental effectiveness of the two alternatives, RRS versus non-RRS). The effectiveness of the RRS, defined as improvements in health outcomes (AE, cardiopulmonary arrest and mortality), was obtained from the literature and applied to the included patient cohort. A budget impact analysis on the implementation of the RRS from a hospital perspective was performed over a 5-year time horizon.

Results

42,409 patients were included, and 448 (1.05%) had severe AE requiring ICU admission. The cost-effectiveness analysis showed an incremental cost (savings) of EUR − 1,471,101 of RRS versus the non-RRS. The budgetary impact showed a cost reduction of EUR 896,762.00 in the first year and EUR 1,588,579.00 from the second to the fifth year.

Conclusions

The present analysis shows the RRS as a dominant, less costly and more effective structure compared to the non-RRS.

中文翻译：

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在三级医院实施快速反应系统。成本效益研究

目的

住院患者中不良事件 (AE) 的发生大大增加了残疾或死亡的风险，对公共卫生产生重大的负面临床和经济影响。为了及早识别有风险的患者并制定预防措施，不同的医疗保健系统已经实施了快速反应系统 (RRS)。本研究的目的是对在三级医院实施 RRS 进行成本效益分析。

方法

我们纳入了 2016 年 1 月至 2016 年 12 月 31 日期间入住巴塞罗那医院诊所的所有患者。成本效益分析总结为增量成本效益比（增量成本除以两种替代方案的增量有效性，RRS与非-RRS）。RRS 的有效性，定义为健康结果（AE、心肺骤停和死亡率）的改善，是从文献中获得的，并应用于纳入的患者队列。从医院的角度对 RRS 实施的预算影响进行了 5 年的时间跨度分析。

结果

纳入了 42,409 名患者，其中 448 名 (1.05%) 患有需要入住 ICU 的严重 AE。成本效益分析显示，与非 RRS 相比，RRS 的增量成本（节省）为 1,471,101 欧元。预算影响显示，第一年的成本减少了 896,762.00 欧元，从第二年到第五年减少了 1,588,579.00 欧元。

结论

目前的分析表明，与非 RRS 相比，RRS 是一种占主导地位、成本更低且更有效的结构。