Evaluating the cost, cost-effectiveness and survival of an eHealth-facilitated integrated care model for allogeneic stem cell transplantation: Results of the German SMILe randomized, controlled implementation science trial.
eHealth-facilitated integrated care models (eICMs) have proved effective in improving outcomes for chronically ill patients. However, evidence on cost-effectiveness of eICMs is scarce so far. Allogeneic stem cell transplantation (alloSCT) recipients' post-discharge treatment costs and mortality are...
| Publicado en: | European Journal of Oncology Nursing Vol. 74 |
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| Autores principales: | , , , , , , , , |
| Formato: | research randomized controlled trial Journal Article |
| Publicado: |
Churchill Livingstone, Inc.
Feb2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=182871855&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 182871855 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14623889 8IF jtl: European Journal of Oncology Nursing issn: 14623889 maglogo: N pubinfo: dt: Feb2025 vid: 74 pid: 1242 pub: Churchill Livingstone, Inc. artinfo: ui: 182871855 182871855 182871855 10.1016/j.ejon.2024.102740 182871855 ppct: 1 formats: tig: atl: Evaluating the cost, cost-effectiveness and survival of an eHealth-facilitated integrated care model for allogeneic stem cell transplantation: Results of the German SMILe randomized, controlled implementation science trial. aug: au: Leppla, Lynn Kaier, Klaus Schmid, Anja Valenta, Sabine Ribaut, Janette Mielke, Juliane Teynor, Alexandra Zeiser, Robert De Geest, Sabina affil: Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, Germany sug: subj: Allogeneic Cells Transplantation Stem Cells Transplantation Cost Effectiveness Analysis Telehealth Health Care Delivery, Integrated Human Germany Randomized Controlled Trials Random Assignment Germany Academic Medical Centers Descriptive Statistics ab: eHealth-facilitated integrated care models (eICMs) have proved effective in improving outcomes for chronically ill patients. However, evidence on cost-effectiveness of eICMs is scarce so far. Allogeneic stem cell transplantation (alloSCT) recipients' post-discharge treatment costs and mortality are greatly influenced by complications. Within the international, multicentric SMILe implementation science project, the eHealth-facilitated SMILe integrated care model (SMILe– ICM) was developed to support patients minimize complications' effects within the first year post-alloSCT. Using initial effectiveness findings from the first center that implemented the SMILe-ICM, this study provides a cost and cost-effectiveness evaluation considering one-year and long-term survival effects, post-discharge costs, and patient-related factors. A single-center hybrid effectiveness implementation randomized controlled trial was conducted at a German university hospital from 2/2020 to 8/2022. Eligible alloSCT patients were randomized to the SMILe–ICM or usual care, i.e., one pre-transplant educational nursing visit followed by a physician-led follow-up. The intervention group received usual care plus the SMILe-ICM's four intervention modules (i.e., monitoring of medical/symptom-related parameters, medication adherence, infection prevention, physical activity). All modules were delivered by Advanced Practice Nurses (APNs) in face-to-face visits, combined with continuous online support. Daily, patients entered seventeen medical and symptom-related parameters to the SMILe App, so that APNs could monitor for and investigate possible pre-complication signs. Healthcare utilization costs were assessed at eight time-points (d+30 post-alloSCT–d365) on fourteen self-reported cost indicators and validated against health records. To calculate costs, we applied German standardized unit costs. Cost- and cost-effectiveness were analyzed in five steps: 1.) Calculate total costs, including for the alloSCT inpatient stay and post-discharge follow-up. 2.) Determine life-years gained (survival) as a health benefit unit. 3.) Calculate overall and rehospitalization-free survival estimates. 4.) Calculate the intervention's long-term cost-effectiveness, including extended follow-up, rate of survival until day 1000, and restricted mean survival time. 5.) Contrast these long-term estimates to current post-discharge costs with comparable patient-related factors (age ≥ or < 65, living alone, gender). Seventy-two patients participated (n = 36/group). Total intergroup healthcare utilization and post-discharge costs differed, but non-significantly. Survival rates improved with the SMILe–ICM (88% vs. 80%) at least until day +1000. Rehospitalization-free survival showed improvement (38% vs. 30%); however, considering this sample size, both findings were nonsignificant. Cost-effectiveness analysis showed an overall post-discharge cost-effectiveness of 35,364.01€/patient and 6,742€/life year gained — a mean of 79.21 additional days of life for an intervention investment of 1.464€/patient in the first year post-alloSCT. One-year cost-effectiveness was highest for patients living alone. Younger age correlated with longer survival but higher costs. The SMILe-ICM appears to offer survival and rehospitalization benefits, particularly for vulnerable groups, e.g., patients living alone. Larger, adequately powered studies are needed to validate these findings. • eHealth-facilitated integrated care models (eICM) can benefit alloSCT recipients. • SMILe–ICM use was correlated with promising survival and rehospitalization rates. • SMILe–ICM was most beneficial and cost-effective in patients living alone. pubtype: Academic Journal doctype: research randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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