Twelve-Month Follow-Up and Economic Evaluation of an Alternative Care Provider Clinic for Severe Sleep-Disordered Breathing.

Longer-term clinical and economic impacts of an ACP model for patients with severe SDB have not been evaluated.

对于严重SDB患者的ACP模式的长期临床和经济影响尚未进行评估。

research_question

Is ACP-led care of SDB effective and cost-effective compared with standard care by a sleep physician?

与睡眠医师的标准护理相比，由ACP（呼吸治疗师）主导的严重睡眠呼吸暂停低通气综合征(SDB)护理是否有效且具有成本效益？

study_design_and_methods

One-year follow-up data from a randomized controlled trialconducted among patients with severe SDB, randomized 1:1 to physician- or ACP (respiratory therapist)-led management is reported.

在一项针对严重SDB患者的随机对照试验中，患者被随机分为1:1，接受医师或ACP（呼吸治疗师）主导的管理，报告了一年的随访数据。

Clinical outcomes included adherence to positive airway pressure therapy and patient-reported outcomes including sleepiness, quality of life, and care satisfaction.

临床结果包括对正压通气治疗的依从性以及患者报告的结果，包括嗜睡、生活质量以及对护理的满意度。

A cost-utility analysis was conducted using trial data and health administrative data, with costs calculated from the perspective of the Canadian public payer and quality-adjusted life years (QALYs) using Health Utility Index scores.

使用试验数据和卫生管理数据进行了成本效用分析，成本是从加拿大公共支付者的角度计算的，质量调整生命年（QALYs）使用健康效用指数评分。

Willingness to pay for incremental cost-effectiveness ratio estimates were summarized with cost-effectiveness acceptability curves.

增量成本效益比的支付意愿通过成本效益接受度曲线进行了总结。

Referral wait times and polysomnogram use were evaluated in subgroup analyses.

在亚组分析中评估了转诊等待时间和多导睡眠图的使用。

Results

Adherence, treatment efficacy, and patient-reported outcomes were similar among ACP-led and standard care arms.

ACP领导的治疗组与标准护理组在依从性、治疗效果和患者报告的结果方面相似。

Mean utility scores improved over the 1-year period in both groups.

两组在1年期间的平均效用评分都有所提高。

The estimated incremental cost-effectiveness ratio associated with the ACP-led group compared with standard care was -$34,580 per QALY.

与标准护理相比，由ACP领导的小组相关的增量成本效益比为每QALY -34,580美元。

The probability the ACP-led clinic was cost-effective compared with standard care was 61.9% at a willingness to pay threshold of $50,000/QALY.

在每QALY支付意愿阈值为50,000美元的情况下，ACP领导的诊所与标准护理相比具有成本效益的概率为61.9%。

Subgroup and sensitivity analyses did not alter results.

亚组和敏感性分析并未改变结果。

interpretation

Our results show that the ACP-led management strategy demonstrated similar clinical outcomes 1 year after treatment initiation.

我们的结果显示，ACP领导的管理策略在治疗开始后1年显示出相似的临床结果。

This model is likely to be cost-effective relative to standard care among patients with severe SDB.

该模型在严重睡眠呼吸暂停低通气综合征（SDB）患者中，与标准治疗相比，可能具有成本效益。

Results were robust to sensitivity analysis and support implementation of the ACP care model in this population.

结果对敏感性分析具有稳健性，并支持在这一人群中实施ACP护理模式。