| Objective:Comparing the clinical effects of acupuncture combined with rehabilitation training and acupuncture alone in the treatment of dysphagia due to stroke,explore the economic advantages of acupuncture and rehabilitation,and seek a more effective and economical treatment plan for patients with dysphagia due to stroke.Optimize the rational allocation of medical and health resources to provide evidence support.Methods:This study is a prospective observational study.The 60 stroke patients with dysphagia that meet the inclusion criteria were divided into combined acupuncture and rehabilitation group and acupuncture group according to their wishes.Among them,30 patients in the combined acupuncture and rehabilitation group used "Tong Guan Li Qiao" Acupuncture combined with rehabilitation training treatment,30 patients in the acupuncture group,only used the " Tong Guan Li Qiao " Acupuncture method,on this basis,both groups of patients received basic treatment for stroke.The study period is 2weeks in total.1.Clinical efficacy evaluation(1)Efficacy comparison based on FOIS score: Functional oral ingestion scale(FOIS)was used to compare the efficacy of each group before and after treatment and between the two groups after treatment.(2)Efficacy comparison based on NIHSS score: The National Institutes of Health Stroke Scale(NIHSS)was used to compare the efficacy of each group before and after treatment and between the two groups after treatment.2.Health Economics Evaluation(1)Health economics evaluation based on FOIS score: FOIS score is used as an effect value indicator,compared with cost for Cost-effectiveness analysis,and calculate cost-effectiveness ration(CER)and incremental cost-effectiveness ration(ICER).(2)Health economics evaluation based on NIHSS score: Using NIHSS scale as the effect value indicator,comparing with cost for cost-effectiveness analysis,and obtaining cost-effectiveness ration(CER)and incremental cost-effectiveness ration(ICER).(3)Health economics evaluation based on QALY: Using quality-adjusted life year(QALY)as the utility index,the health utility value is calculated by the British SF-6D utility scoring model based on SF-36,and then the area under the curve method is used to calculate QALY.the Compare with the QALY of the acupuncture groupand combined acupuncture and rehabilitation group,perform cost-utility analysis,and calculate the cost-utility ration(CUR)and the incremental cost-utility ration(ICUR).(4)Sensitivity analysis was conducted to test the reliability of the results from two aspects: a 10% increase in acupuncture costs with a 10% reduction in rehabilitation costs,and a 10% reduction in acupuncture costs,with a 10% increase in rehabilitation costs.Results:1 Baseline comparisonThe baseline between the acupuncture group and the acupuncture group is consistent and comparable.2 Clinical efficacy evaluation results:(1)Comparison of efficacy based on FOIS score: After treatment,the FOIS score of the combined acupuncture and rehabilitation group increased from 5.00(5.00,6.00)to 6.00(6.00,7.00),and that of the acupuncture group increased from 5.00(4.00,5.00)to 6.00(5.00,6.00).The scores of each group before and after treatment and the scores of the two groups after treatment had statistical significance(P < 0.05).(2)Comparison of efficacy based on NIHSS score: After treatment,the NIHSS score of the combined acupuncture and rehabilitation group decreased from 7.50(6.00,9.25)to 4.00(3.00,6.00),and that of the acupuncture group decreased from 7.50(5.00,8.25)to 5.50(4.00,7.00).The scores of each group before and after treatment and the scores of the two groups after treatment had statistical significance(P < 0.05).3 Health Economics Evaluation:(1)Health economics evaluation based on FOIS score: After 2 weeks of treatment,the two groups patients have the same FOIS score.Therefore,cost-minimization analysis is adopted.The results show that to achieve the same therapeutic effect,the cost of the acupuncture group is 2520 RMB.The cost of the acupuncture group is 1,620 RMB,and the cost of the acupuncture group is higher than that of the acupuncture group.(2)Health economics evaluation based on the NIHSS score: cost-effectiveness analysis and incremental analysis of the cost and effect value of the two groups of patients.The cost-effectiveness analysis results show that for every 1 point reduction in the NIHSS score,the cost of the combined acupuncture and rehabilitation group is1043.33 RMB,and the cost of the acupuncture group is 810 RMB.The acupuncture group has a lower cost-effectiveness ratio and is aimed at the recovery of neurological deficits.To achieve the same therapeutic effect,the cost of the acupuncture group is lower than that of combined acupuncture and rehabilitation group.Incremental analysis showed that compared with the combined acupuncture and rehabilitation group,each increase of 1 point in the NIHSS score of the acupuncture group would cost 1,354.45 RMB more.(3)Health economics evaluation based on QALY: The cost-utility analysis of the cost and QALY of the two groups of patients shows that the cost of each QALY obtained in the combined acupuncture and rehabilitation group is 4,498.95 RMB.The cost of each QALY obtained is 1,485.97 RMB.During the treatment,the QALY of the acupuncture group is lower than that of the acupuncture group,so that ΔQALY<0.Compared with the acupuncture group,the cost of the acupuncture group is less and the QALY obtained is more,Belongs to the superior plan,the acupuncture group has better cost-effective advantages,and subsequent incremental analysis is not required.(4)Sensitivity analysis: A sensitivity analysis was conducted in terms of a 10%increase in acupuncture costs with a 10% reduction in rehabilitation costs,and a 10%reduction in acupuncture costs with a 10% increase in rehabilitation costs.The results showed that cost changes did not affect the health economics mentioned above.The evaluation results have an impact,indicating that the above results are reliable.Conclusion:1.Acupuncture combined with rehabilitation treatment has definite efficacy compared with acupuncture alone.Compared with acupuncture alone,acupuncture combined with rehabilitation treatment has better efficacy in improving the symptoms of swallowing function and neurological function deficit.However,acupuncture alone has more economic advantages in the recovery of swallowing function,the improvement of nerve function defect and the comprehensive improvement of life quality and length.2.It is more appropriate to popularize the combined application of acupuncture and rehabilitation in third-class A hospitals and large and medium-sized cities where the economic foundation is consolidated and the basic equipment is perfect and the efficacy is maximized;It is more suitable to popularize simple acupuncture therapy in basic hospitals and poor mountainous areas where economic strength is relatively insufficient and medical resources are relatively limited.It is worthwhile to carry out follow-up studies on acupuncture to improve the acupoint selection scheme,acupuncture manipulation,treatment frequency,etc.,to find advantageous schemes,enhance the curative effect,strengthen the construction of acupuncture theoretical system and application system,so as to achieve the goal of "taking measures according to disease and individual conditions" and promote the development of acupuncture standardization. |
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