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Subgroup analysis of telehealthcare for patients with chronic obstructive pulmonary disease: the cluster-randomized Danish Telecare North Trial

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العنوان: Subgroup analysis of telehealthcare for patients with chronic obstructive pulmonary disease: the cluster-randomized Danish Telecare North Trial
المؤلفون: Witt Udsen F, Lilholt PH, Hejlesen OK, Ehlers LH
المصدر: ClinicoEconomics and Outcomes Research, Vol Volume 9, Pp 391-401 (2017)
بيانات النشر: Dove Medical Press, 2017.
سنة النشر: 2017
المجموعة: LCC:Medicine (General)
LCC:Therapeutics. Pharmacology
مصطلحات موضوعية: COPD, telemonitoring, telehealth, health economics, heterogeneity, Denmark., Medicine (General), R5-920, Therapeutics. Pharmacology, RM1-950
الوصف: Flemming Witt Udsen,1 Pernille H Lilholt,2 Ole K Hejlesen,2 Lars H Ehlers1 1Danish Centre for Healthcare Improvements, Aalborg University, Aalborg, Denmark; 2Department of Health Science and Technology, Aalborg University, Aalborg, Denmark Purpose: Results from the Danish cluster-randomized trial of telehealthcare to 1,225 patients with chronic obstructive pulmonary disease (COPD), the Danish Telecare North Trial, concluded that the telehealthcare solution was unlikely to be cost-effective, by applying international willingness-to-pay threshold values. The purpose of this article was to assess potential sources of variation across subgroups, which could explain overall cost-effectiveness results or be utilized in future economic studies in telehealthcare research. Methods: First, the cost-structures and cost-effectiveness across COPD severities were analyzed. Second, five additional subgroup analyses were conducted, focusing on differences in cost-effectiveness across a set of comorbidities, age-groups, genders, resource patterns (resource use in the social care sector prior to randomization), and delivery sites. All subgroups were ­investigated post hoc. In analyzing cost-effectiveness, two separate linear mixed-effects models with treatment-by-covariate interactions were applied: one for quality-adjusted life-year (QALY) gain and one for total healthcare and social sector costs. Probabilistic sensitivity analysis was used for each subgroup result in order to quantify the uncertainty around the cost-effectiveness results. Results: The study concludes that, across the COPD severities, patients with severe COPD (GOLD 3 classification) are likely to be the most cost-effective group. This is primarily due to lower hospital-admission and primary-care costs. Telehealthcare for patients younger than 60 years is also more likely to be cost-effective than for older COPD patients. Overall, results indicate that existing resource patterns of patients and variations in delivery-site practices might have a strong influence on cost-effectiveness, possibly stronger than the included health or sociodemographic sources of heterogeneity. Conclusion: Future research should focus more on sources of heterogeneity found in the implementation context and the way telehealthcare is adopted (eg, by integrating formative evaluation into cost-effectiveness analyses). Trial registration: Clinicaltrials.gov, NCT01984840. Keywords: COPD, telemonitoring, telehealth, health economics, heterogeneity, Denmark
نوع الوثيقة: article
وصف الملف: electronic resource
اللغة: English
تدمد: 1178-6981
Relation: https://www.dovepress.com/subgroup-analysis-of-telehealthcare-for-patients-with-chronic-obstruct-peer-reviewed-article-CEOR; https://doaj.org/toc/1178-6981
URL الوصول: https://doaj.org/article/97feb95f5c4d4e6090b02fa1b915cc49
رقم الأكسشن: edsdoj.97feb95f5c4d4e6090b02fa1b915cc49
قاعدة البيانات: Directory of Open Access Journals
الوصف
تدمد:11786981