Background In advanced disease, breathlessness becomes severe, increasing health services use. Breathlessness triggered services demonstrate effectiveness in trials and meta-analyses but lack health economic assessment. Methods Our economic study included a discrete choice experiment (DCE), followed by a cost-effectiveness analysis modelling. The DCE comprised face-to-face interviews with older patients with chronic breathlessness and their carers across nine UK centres. Conditional logistic regression analysis of DCE data determined the preferences (or not, indicated by negative β coefficients) for service attributes. Economic modelling estimated the costs and quality-adjusted life years (QALYs) over 5 years. Findings The DCE recruited 190 patients and 68 carers. Offering breathlessness services in person from general practitioner (GP) surgeries was not preferred (β=−0.30, 95% CI −0.40 to −0.21); hospital outpatient clinics (0.16, 0.06 to 0.25) or via home visits (0.15, 0.06 to 0.24) were preferred. Inperson services with comprehensive treatment review (0.15, 0.07 to 0.21) and holistic support (0.19, 0.07 to 0.31) were preferred to those without. Cost-effectiveness analysis found the most and the least preferred models of breathlessness services were cost-effective compared with usual care. The most preferred service had £5719 lower costs (95% CI −6043 to 5395), with 0.004 (95% CI −0.003 to 0.011) QALY benefits per patient. Uptake was higher when attributes were tailored to individual preferences (86% vs 40%). Conclusion Breathlessness services are cost-effective compared with usual care for health and social care, giving cost savings and better quality of life. Uptake of breathlessness services is higher when service attributes are individually tailored. Data are available upon reasonable request. We can share the protocol, consent form, analysis plan, training and other relevant DCE materials. Data from the survey are approved for use by the research team and appropriately qualified researchers trained and supervised by them. Fully anonymised data with other studies for secondary analysis could be considered. De-identified participant data will be made available to bona fide researchers registered with an appropriate institution within 3 months of publication. However, the research team will need to be satisfied that any proposed publication is of high quality, honours the commitments made to the study participants in the consent documentation and ethical approvals, and is compliant with relevant legal and regulatory requirements (eg, relating to data protection and privacy). The research team will have the right to review and comment on any draft manuscripts before publication. Data will be made available in line with the policy and procedures of the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation. Those wishing to request access should email deok_hee.yi@kcl.ac.uk.

中文翻译：

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优化呼吸困难引发的针对患有晚期疾病的老年人的服务：一项多中心经济研究 (OPTBreathe)


背景 在疾病晚期，呼吸困难变得严重，从而增加了卫生服务的使用。呼吸困难引发的服务在试验和荟萃分析中显示出有效性，但缺乏健康经济评估。方法我们的经济研究包括离散选择实验（DCE），然后是成本效益分析模型。 DCE 对英国九个中心的慢性呼吸困难老年患者及其护理人员进行了面对面访谈。 DCE 数据的条件逻辑回归分析确定了对服务属性的偏好（或不偏好，由负 β 系数表示）。经济模型估计了 5 年的成本和质量调整生命年 (QALY)。结果 DCE 招募了 190 名患者和 68 名护理人员。不推荐全科医生 (GP) 亲自提供呼吸困难服务（β=-0.30，95% CI -0.40 至 -0.21）；首选医院门诊（0.16、0.06至0.25）或家访（0.15、0.06至0.24）。与没有综合治疗审查（0.15、0.07 至 0.21）和整体支持（0.19、0.07 至 0.31）的面对面服务相比，更受青睐。成本效益分析发现，与常规护理相比，最受欢迎和最不受欢迎的呼吸困难服务模式具有成本效益。最受青睐的服务成本较低 5719 英镑（95% CI -6043 至 5395），每位患者的 QALY 效益为 0.004（95% CI -0.003 至 0.011）。当属性根据个人偏好定制时，采用率更高（86% vs 40%）。结论 与常规的健康护理和社会护理相比，呼吸困难服务具有成本效益，可以节省成本并提高生活质量。当服务属性是单独定制时，呼吸困难服务的使用率会更高。 数据可根据合理要求提供。我们可以分享方案、同意书、分析计划、培训和其他相关 DCE 材料。调查数据经研究团队和受其培训和监督的适当合格研究人员批准使用。可以考虑将完全匿名的数据与其他研究进行二次分析。去识别化的参与者数据将在发布后 3 个月内提供给在适当机构注册的善意研究人员。然而，研究团队需要确信任何拟议的出版物都是高质量的，履行在同意文件和道德批准中向研究参与者做出的承诺，并且符合相关的法律和监管要求（例如，与数据相关的要求）。保护和隐私）。研究团队有权在出版前对任何稿件进行审阅和评论。数据将根据西塞莉桑德斯姑息治疗、政策和康复研究所的政策和程序提供。那些希望请求访问的人应发送电子邮件至 deok_hee.yi@kcl.ac.uk。