@文章{信息:doi/10.2196/31302，作者=“Albuquerque de Almeida, Fernando and Corro Ramos, Isaac and Al, Maiwenn and Rutten-van M{\ \ o}lken, Maureen”，标题=“家庭远程监测和诊断算法在荷兰心力衰竭管理:成本效益分析”，期刊=“JMIR Cardio”，年=“2022”，月=“8”，日=“4”，卷=“6”，数=“2”，页=“e31302”，关键词=“离散事件模拟;成本效益;预警系统;远程控制;诊断算法;背景:心力衰竭是一种主要的健康问题，与患者的发病率、死亡率和生活质量降低有关。家庭远程监测(HTM)有助于频繁或持续地评估疾病体征和症状，并已证明通过让患者参与自己的护理来提高依从性，并通过促进早期发现临床重大变化来防止紧急入院。诊断算法(DAs)是一种预测性的数学关系，它利用广泛收集的数据来计算特定事件的可能性，并使用该输出来确定患者的治疗优先级。目的:本研究旨在评估HTM和DA在荷兰心力衰竭管理中的成本效益。分析了三种干预措施:常规护理、HTM和HTM加DA。 Methods: A previously published discrete event simulation model was used. The base-case analysis was performed according to the Dutch guidelines for economic evaluation. Sensitivity, scenario, and value of information analyses were performed. Particular attention was given to the cost-effectiveness of the DA at various levels of diagnostic accuracy of event prediction and to different patient subgroups. Results: HTM plus the DA extendedly dominates HTM alone, and it has a deterministic incremental cost-effectiveness ratio compared with usual care of {\texteuro}27,712 (currency conversion rate in purchasing power parity at the time of study: {\texteuro}1=US {\$}1.29; further conversions are not applicable in cost-effectiveness terms) per quality-adjusted life year. The model showed robustness in the sensitivity and scenario analyses. HTM plus the DA had a 96.0{\%} probability of being cost-effective at the appropriate {\texteuro}80,000 per quality-adjusted life year threshold. An optimal point for the threshold value for the alarm of the DA in terms of its cost-effectiveness was estimated. New York Heart Association class IV patients were the subgroup with the worst cost-effectiveness results versus usual care, while HTM plus the DA was found to be the most cost-effective for patients aged <65 years and for patients in New York Heart Association class I. Conclusions: Although the increased costs of adopting HTM plus the DA in the management of heart failure may seemingly be an additional strain on scarce health care resources, the results of this study demonstrate that, by increasing patient life expectancy by 1.28 years and reducing their hospitalization rate by 23{\%} when compared with usual care, the use of this technology may be seen as an investment, as HTM plus the DA in its current form extendedly dominates HTM alone and is cost-effective compared with usual care at normally accepted thresholds in the Netherlands. ", issn="2561-1011", doi="10.2196/31302", url="https://cardio.www.mybigtv.com/2022/2/e31302", url="https://doi.org/10.2196/31302", url="http://www.ncbi.nlm.nih.gov/pubmed/35925670" }