Unit costs of monitoring and inpatient stay.

BackgroundDelayed response to clinical deterioration of hospital inpatients is common. Deployment of an electronic automated advisory vital signs monitoring and notification system to signal clinical deterioration is associated with significant improvements in clinical outcomes but there is no evidence on the cost-effectiveness compared with routine monitoring, in the National Health Service (NHS) in the United Kingdom (UK).MethodsA decision analytic model was developed to estimate the cost-effectiveness of an electronic automated advisory notification system versus standard care, in adults admitted to a district general hospital. Analyses considered: (1) the cost-effectiveness of the technology based on secondary analysis of patient level data of 3787 inpatients in a before-and-after study; and (2) the cost-utility (cost per quality-adjusted life-year (QALY)) over a lifetime horizon, extrapolated using published data. Analysis was conducted from the perspective of the NHS. Uncertainty in the model was assessed using a range of sensitivity analyses.ResultsThe study population had a mean age of 68 years, 48% male, with a median inpatient stay of 6 days. Expected life expectancy at discharge was assumed to be 17.74 years.(1) Cost-effectiveness analysis: The automated notification system was more effective (-0.027 reduction in mean events per patient) and provided a cost saving of -£12.17 (-182.07 to 154.80) per patient admission.(2) Cost-utility analysis: Over a lifetime horizon the automated notification system was dominant, demonstrating a positive incremental QALY gain (0.0287 QALYs, equivalent to ~10 days of perfect health) and a cost saving of £55.35. At a threshold of £20,000 per QALY, the probability of automated monitoring being cost-effective in the NHS was 81%. Increased use of cableless sensors may reduce cost-savings, however, the intervention remains cost-effective at 100% usage (ICER: £3,107/QALY). Stratified cost-effectiveness analysis by age, National Early Warning Score (NEWS) on admission, and primary diagnosis indicated the automated notification system was cost-effective for most strategies and that use representative of the patient population studied was the most cost-saving strategy.ConclusionAutomated notification system for adult patients admitted to general wards appears to be a cost-effective use in the NHS; adopting this technology could be good use of scarce resources with significance for patient safety.背景 医院住院患者病情恶化应对延迟的情况十分常见。在英国（United Kingdom, UK）国民保健服务（National Health Service, NHS）体系中，部署电子自动化预警生命体征监测与通知系统以触发病情恶化预警，可显著改善临床结局，但目前尚无该系统相较于常规监测的成本效益相关证据。 研究方法 本研究构建决策分析模型，以评估地区综合医院住院成年患者使用电子自动化预警通知系统相较于标准护理的成本效益。分析维度包括：(1) 基于一项前后对照研究中3787名住院患者的个体数据二次分析，评估该技术的成本效益；(2) 利用已发表数据外推，测算终身视角下的成本效用比（每质量调整生命年成本，quality-adjusted life-year, QALY）。本研究从国民保健服务（NHS）视角开展分析，并通过一系列敏感性分析评估模型的不确定性。 研究结果 研究队列的平均年龄为68岁，男性占比48%，住院时长中位数为6天。假设患者出院时预期剩余寿命为17.74年。 (1) 成本效益分析：自动化预警通知系统的临床效果更优（每名患者的平均不良事件数减少0.027例），且每例患者住院可节省12.17英镑（区间：-182.07至154.80英镑）。 (2) 成本效用分析：在终身视角下，自动化预警通知系统占据成本效用优势：增量质量调整生命年增益为正（0.0287 QALYs，约等同于10天的完全健康状态），且可节省55.35英镑。在每QALY 20000英镑的支付意愿阈值下，国民保健服务（NHS）体系中自动化监测具备成本效益的概率为81%。增加无线传感器的使用可能会降低成本节省幅度，但即便100%使用该传感器，该干预措施仍具备成本效益（增量成本效果比（Incremental Cost-Effectiveness Ratio, ICER）：3107英镑/QALY）。按年龄、入院时国家早期预警评分（National Early Warning Score, NEWS）及主要诊断进行分层的成本效益分析显示，自动化预警通知系统在多数亚组中均具备成本效益，其中以研究队列患者人群为代表的使用场景成本节省效果最优。 结论 针对综合病房住院成年患者的自动化预警通知系统，在英国国民保健服务（NHS）体系中具备成本效益；推广该技术可高效利用稀缺医疗资源，对患者安全具有重要意义。