运用健康经济学进行操作模型化，为 COPD 患者的决策提供支持。
Operational Modeling with Health Economics to Support Decision Making for COPD Patients.
机构信息
Hertfordshire Business School, University of Hertfordshire, Hatfield, UK.
UCL Respiratory, University College London, London, UK.
出版信息
Health Serv Res. 2021 Dec;56(6):1271-1280. doi: 10.1111/1475-6773.13652. Epub 2021 Mar 22.
OBJECTIVE
To assess the impact of interventions for improving the management of chronic obstructive pulmonary disease (COPD), specifically increased use of pulmonary rehabilitation (PR) on patient outcomes and cost-benefit analysis.
DATA SOURCES
We used the national Hospital Episode Statistics (HES) datasets in England, local data and experts from the hospital setting, National Prices and National Tariffs, reports and the literature around the effectiveness of PR programs.
STUDY DESIGN
The COPD pathway was modeled using discrete event simulation (DES) to capture the patient pathway to an adequate level of detail as well as randomness in the real world. DES was further enhanced by the integration of a health economic model to calculate the net benefit and cost of treating COPD patients based on key sets of interventions.
DATA COLLECTION/EXTRACTION METHODS: A total of 150 input parameters and 75 distributions were established to power the model using the HES dataset, outpatient activity data from the hospital and community services, and the literature.
PRINCIPAL FINDINGS
The simulation model showed that increasing referral to PR (by 10%, 20%, or 30%) would be cost-effective (with a benefit-cost ratio of 5.81, 5.95, and 5.91, respectively) by having a positive impact on patient outcomes and operational metrics. Number of deaths, admissions, and bed days decreased (ie, by 3.56 patients, 4.90 admissions, and 137.31 bed days for a 30% increase in PR referrals) as well as quality of life increased (ie, by 5.53 QALY among 1540 patients for the 30% increase).
CONCLUSIONS
No operational model, either statistical or simulation, has previously been developed to capture the COPD patient pathway within a hospital setting. To date, no model has investigated the impact of PR on COPD services, such as operations, key performance, patient outcomes, and cost-benefit analysis. The study will support policies around extending availability of PR as a major intervention.
目的
评估改善慢性阻塞性肺疾病（COPD）管理的干预措施的影响，特别是增加肺康复（PR）的使用对患者结局和成本效益分析的影响。
数据来源
我们使用了英国国家住院患者统计数据（HES）数据集、当地数据以及医院环境中的专家、国家价格和国家关税、围绕 PR 计划有效性的报告和文献。
研究设计
使用离散事件模拟（DES）对 COPD 路径进行建模，以详细捕捉患者路径，并考虑现实世界中的随机性。DES 进一步通过整合健康经济模型得到增强，该模型根据关键干预集计算治疗 COPD 患者的净效益和成本。
数据收集/提取方法：使用 HES 数据集、医院和社区服务的门诊活动数据以及文献，共建立了 150 个输入参数和 75 个分布，为模型提供动力。
主要发现
模拟模型表明，通过增加对 PR 的转诊（增加 10%、20%或 30%），将对患者结局和运营指标产生积极影响，从而具有成本效益（分别具有 5.81、5.95 和 5.91 的效益成本比）。死亡人数、入院人数和住院天数减少（即，PR 转诊增加 30%时，患者人数减少 3.56 人，入院人数减少 4.90 人，住院天数减少 137.31 天），生活质量提高（即，1540 名患者中 PR 转诊增加 30%时，QALY 增加 5.53）。
结论
以前没有开发过统计或模拟的运营模型来捕捉医院环境中的 COPD 患者路径。迄今为止，尚无模型研究 PR 对 COPD 服务（如运营、关键绩效、患者结局和成本效益分析）的影响。该研究将支持围绕扩大 PR 可用性作为主要干预措施的政策。
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