ECONOMIC EVALUATION OF CLINICAL PATHWAYS MANAGEMENT FOR CEREBRAL INFARCTION IN RURAL AREA OF CHINA
Author(s)
Wudong G1, Li X2, Wang Y1, Zhao K1
1China National Health Development Research Center, Beijing, China, 2CHINA NATIONAL HEALTH DEVELOPMENT RESEARCH CENTER, Beijing, China
OBJECTIVES : Ongoing reforms to China’s county-level public hospitals have generated an interest in developing evidence-based clinical pathways (CP). A pilot project in four counties has been embarked, linked with payment reform on cerebral infarction inpatient subjects. This study aimed to understand the impacts of the CP comprehensive intervention on treatment effectiveness and the use of resources. METHODS : A retrospective observational study was conducted using de-identified data collected from four pilot sites. A mixed-methods approaches have been adopted to process the data analysis, including propensity score matching (PSM), interrupted time series (ITS) with segmented regression, and cost-effectiveness analysis (CEA). Prior to ITS analysis, the PSM was employed to ensure the similarity of baseline characteristics between pre and post groups. Then ITS analysis has been performed to describe the overall effects of the intervention on pre-defined outcomes. Afterwards, a CEA analysis has been developed using Markov model with the help of Tree-age software, to calculate the incremental cost effectiveness ratio(ICER). Meanwhile, the probability sensitivity analysis (PSA) was performed to testify the influential factors. RESULTS : Out of 2753 patients, 765 subjects were included after using the nearest neighbor PSM for age, gender, severity of disease, number of complications. The ITS analyses results showed that the advantage of CP intervention in term of average length of stay, total hospitalization expenses, medication costs, laboratory expenses, and quality-adjusted life years (QALY) estimated by EQ-5D. The ICER was 16756 RMB/QALY, which favored the choice of CP intervention compared to threshold. The PSA analysis showed that age, the number of days in hospital, and admittance of CP are the top three influential factors in sensitivity analysis. CONCLUSIONS : The evaluation findings and lessons learned from the pilots were widely discussed and disseminated to policy-makers to enable evidence-based decision-making for CP implementation in rural China.
Conference/Value in Health Info
2020-05, ISPOR 2020, Orlando, FL, USA
Value in Health, Volume 23, Issue 5, S1 (May 2020)
Code
PND53
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Methodological & Statistical Research, Real World Data & Information Systems
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Health & Insurance Records Systems, Prescribing Behavior
Disease
Neurological Disorders