TY -的盟Valenzuela埃斯皮诺萨,亚历克西斯盟——狄维士,斯蒂芬妮AU -范•胡芙博士,Robbert-Jan盟——Fobelets Maaike AU -杜邦,阿兰盟,摩恩Maarten盟——Hubloue艾夫斯盟——Lauwaert门非盟-角,Pieter AU -博朗,Raf AU -核,柯恩PY - 2017 DA - 2017/11/24 TI - In-Ambulance所需时间获得远程医疗:成本效用模型乔- JMIR Mhealth Uhealth SP - e175六世- 5 - 11 KW -远程医疗千瓦送往医院之前的KW -中风KW -成本效益AB -背景:中风是一种对时间非常敏感的病理，许多新的解决方案针对院前中风护理的优化，以改善中风管理过程。救护车内远程医疗是指在移动的救护车中，病人和神经科医生之间的实时双向音频视频以及重要参数的自动传输，是一种有前途的加速和提高急性中风护理质量的新方法。目前，尚无证据表明救护车内远程医疗的成本效益。目的:我们的目标是为救护车远程医疗开发第一个成本效益模型，并使用该模型来估计在救护车远程医疗成为成本效益之前所需的时间节省。方法:从医疗保健的角度，采用成本-效用模型测量成本和质量调整生命年(QALYs)，将当前标准卒中护理与补充救护车远程医疗的当前标准卒中护理进行比较。我们将决策树与马尔可夫模型结合起来。来自UZ布鲁塞尔中风登记处(2282名中风患者)的数据和个人水平的相关医院索赔数据与文献数据相结合，以填充模型。执行了改变实施成本和时间收益的双向敏感性分析，以映射不同的成本效益组合，并确定成本效益和主导地位所需的时间收益。对于几个建模的时间增益，计算成本-效果可接受度曲线，并将其映射到一个图中。 Results: Under the base-case scenario (implementation cost of US $159,425) and taking a lifetime horizon into account, in-ambulance telemedicine is a cost-effective strategy compared to standard stroke care alone starting from a time gain of 6 minutes. After 12 minutes, in-ambulance telemedicine becomes dominant, and this results in a mean decrease of costs by US –$30 (95% CI –$32 to –$29) per patient with 0.00456 (95% CI 0.00448 to 0.00463) QALYs on average gained per patient. In over 82% of all probabilistic simulations, in-ambulance telemedicine remains under the cost-effectiveness threshold of US $47,747. Conclusions: Our model suggests that in-ambulance telemedicine can be cost effective starting from a time gain of 6 minutes and becomes a dominant strategy after approximately 15 minutes. This indicates that in-ambulance telemedicine has the potential to become a cost-effective intervention assuming time gains in clinical implementations are realized in the future. SN - 2291-5222 UR - http://mhealth.www.mybigtv.com/2017/11/e175/ UR - https://doi.org/10.2196/mhealth.8288 UR - http://www.ncbi.nlm.nih.gov/pubmed/29175808 DO - 10.2196/mhealth.8288 ID - info:doi/10.2196/mhealth.8288 ER -