在全球范围内,心力衰竭的负担正在上升。住院是心力衰竭负担的主要原因之一,不幸的是,大多数心力衰竭患者在其一生中会经历多次住院治疗。考虑到与心力衰竭相关的高医疗保健成本,有必要对出院后心力衰竭服务的经济评估进行审查。
急性心力衰竭住院患者出院后护士主导的心力衰竭服务的经济学评价综合综述。
使用EBSCOHost:CINAHL完成搜索电子数据库,Medline完成,Embase,Scopus,EconLit,全球卫生,和健康来源(消费者和护理/学术)发表的文章,直到2021年6月22日。搜索的重点是检查护士主导的诊所或涉及护士的远程监护的成本效益的论文,以在急性心力衰竭住院后对患者进行随访。使用等级标准和CHEERS检查表来确定证据的质量和经济评估的报告质量。
在确定的453项研究中,包括8项研究:4项在心力衰竭诊所,4项在远程监护项目.其中五篇是成本效益分析,一项是成本比较,两项研究涉及经济建模。在五项研究中,等级标准被评为高。其中,四项研究检查了远程监控项目的成本效益.根据经济评估报告质量的CHEERS核对表,大多数经济评估的评级在86%至96%之间。所有研究发现,与常规护理相比,干预措施具有成本效益,增量成本效益比从18259美元/生命年增加到每质量调整生命年增加40,321欧元。
护士主导的心力衰竭诊所和远程监护计划被发现具有成本效益。当然,本综述显示,心力衰竭诊所和远程监护项目确实体现了物有所值,通过减少再住院,其影响和成本节约最大.
Globally the burden of heart failure is rising. Hospitalisation is one of the main contributors to the burden of heart failure and unfortunately, the majority of heart failure patients will experience multiple hospitalisations over their lifetime. Considering the high health care cost associated with heart failure, a review of economic evaluations of post-discharge heart failure services is warranted.
An integrated review of the economic evaluations of post-discharge nurse-led heart failure services for patients hospitalised with acute heart failure.
Electronic databases were searched using EBSCOHost: CINAHL complete, Medline complete, Embase, Scopus, EconLit, Global Health, and Health source (Consumer and Nursing/Academic) for published articles until 22nd June 2021. The searches focussed on papers that examined the cost-effectiveness of nurse-led clinics or telemonitoring involving nurses to follow-up patients after hospitalisation for acute heart failure. GRADE criteria and CHEERS checklist were used to determine the quality of the evidence and the quality of reporting of the economic evaluation.
Out of 453 studies identified, eight studies were included: four in heart failure clinics and four in telemonitoring programs. Five of the articles were cost-effectiveness analyses, one a cost comparison and two studies involved economic modelling The GRADE criteria were rated as high in five studies. In which, four studies examined the cost-effectiveness of telemonitoring programs. Based on the CHEERS checklist for reporting quality of economic evaluations, the majority of economic evaluations were rated between 86 and 96%. All the studies found the intervention to be cost-effective compared to usual care with Incremental Cost Effectiveness Ratios ranging from $18 259 (Canadian dollars)/life year gained to €40,321 per Quality Adjusted Life Years gained.
Nurse-led heart failure clinics and telemonitoring programs were found to be cost-effective. Certainly, this review has shown that heart failure clinics and telemonitoring programs do represent value for money with their greatest impact and cost savings through reducing rehospitalisations.