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脑卒中康复治疗的成本效果研究
刘跃华
王志鹏
齐海梅
作者及单位信息
·
DOI： 10.3760/cma.j.issn.0254-9026.2018.06.023
The cost-effectiveness of stroke rehabilitation care: a systematic review of randomized controlled trails studies
Liu Yuehua
Wang Zhipeng
Qi Haimei
Authors Info & Affiliations
Liu Yuehua
China National Health Development Research Center, Beijing 100084, China
Wang Zhipeng
Tsinghua University Department of Hospital Management, Shenzhen 518057, China
Qi Haimei
Department of Geriatric Medicine, Beijing Hospital, Beijing 100730, China
·
DOI： 10.3760/cma.j.issn.0254-9026.2018.06.023
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摘要

目的对国际发表的脑卒中患者康复治疗的随机对照试验研究(RCTs)的成本效果评估文献进行系统分析，为我国康复治疗的医疗保险支付及临床治疗决策提供循证依据。

方法纳入公开发表的脑卒中康复治疗与传统治疗的RCT研究，对治疗效果、资源利用及成本等产出指标进行研究汇总。

结果纳入8项RCT研究，其中4篇文献涉及支持性早期出院计划(ESD)，较传统治疗成本低，临床效果相似(3篇)或更好(1篇)；2篇文献涉及家庭康复治疗，成本具有中立性或较低各1篇，临床效果差异无统计学意义( P>0.05)；1篇文献涉及卒中单元照顾，较传统治疗临床效果好，但成本高；1篇文章涉及整合卒中服务，较传统治疗成本低，临床效果差异无统计学意义( P>0.05)。

结论脑卒中患者加大康复治疗的投入具有较好的成本效果优势，积极推动康复治疗会带来临床收益，对提高医疗资源利用效率、提高患者生存质量等具重要意义。

卒中;康复;费用效益分析
ABSTRACT

ObjectiveTo perform a systematic review of the literature on the cost-effectiveness of stroke rehabilitation care, and to provide evidence for medical insurance payment and clinical decision making on stroke rehabilitation care.

MethodsWe included published randomized controlled trails(RCTs)which compared rehabilitation care(RC)and usual care(UC)on stroke, and summarized clinical outcome, resource use, costs, and other indexes as outcomes of interest.

ResultsAmong included eight RCT studies, the results of four models of stroke care were found as following.(1)Four studies involving early supported discharge(ESD)showed lower costs in rehabilitation care, but similar(n=3)or better(n=1)clinical outcome.(2)Two studies involving home-based rehabilitation showed similar costs in one and lower costs in the other, with no difference in clinical outcome between two trials.(3)One study involving stroke unit care showed higher costs and better clinical outcome.(4)One trial involving integration stroke service was associated with lower costs, but no difference in the effectiveness.

ConclusionsFor patients with stroke, rehabilitation care leads to significant improvements on cost-effectiveness.Promoting the clinical use of rehabilitation care will bring about clinical benefits, increase the efficiency of medical resources use, and improve patient′s quality of life.

Stroke;Rehabilitation;Cost-benefit analysis
Qi Haimei, Email: mocdef.6ab2120686mhq
Ministry of Education of China Foundation for Humanities and Social Sciences Young Scholars(16YJCZH064); Natural Science Foundation of Beijing for Young Scholars(9174035)
Copyright by Chinese Medical Association
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引用本文

刘跃华,王志鹏,齐海梅. 脑卒中康复治疗的成本效果研究[J]. 中华老年医学杂志,2018,37(6)：702-706.

DOI:10.3760/cma.j.issn.0254-9026.2018.06.023

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近年来随着脑卒中患者数量不断增长，同时诊疗技术水平的提高带来脑卒中患者存活率上升，但致残率高达80%以上 [ 1 , 2 ]。据统计，我国每年脑卒中预防和治疗负担高达190多亿元。2005年Wang等 [ 3 ]对脑卒中卫生总费用进行估计，推算2003年全国脑出血直接医疗费用负担为91.34亿元，缺血性脑卒中的直接住院负担为107.53亿元，脑卒中的总费用负担为198.87亿元，占当年国家医疗总费用的3.79%，国家卫生总费用的3.02%。2016年5月由美国心脏协会/美国卒中协会(AHA/ASA)发布了首部成人卒中康复指南，建议建立由患者、亲属、社区医疗护理提供者、医生、护士、物理治疗师、语言病理学家、社会工作者等多学科共同参与综合治疗，对最大限度地增加康复的有效性和效率至关重要；患者在从急诊出院前应制定全面护理过渡和出院后规划 [ 4 ]。
本研究于2017年1—5月纳入国际文献关于脑卒中康复的卫生经济学评价的高质量证据——随机对照试验研究(RCT)，对脑卒中康复治疗的临床效果和疾病成本进行汇总，以期为决策者提供高质量的循证依据。
参考文献
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备注信息
A
齐海梅，Email： mocdef.6ab2120686mhq
B
无
C
2017年北京自然科学青年基金 (9174035)
2016年教育部人文社科青年基金资助 (16YJCZH064)
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