内镜下切除术与腹腔镜切除术在治疗复杂性结肠息肉中的应用-经济分析
Endoscopic resection is cost-effective compared with laparoscopic resection in the management of complex colon polyps- an economic analysis
Abstract
BACKGROUND AND AIMS:
Endoscopic resection (ER) is an efficacious treatment for complex colon polyps (CCPs). Many patients are referred for surgical resection because of concerns over procedural safety, incomplete polyp resection, and adenoma recurrence after ER. Efficacy data for both resection strategies are widely available, but a paucity of data exist on the cost-effectiveness of each modality. The aim of this study was to perform an economic analysis comparing ER and laparoscopic resection (LR) strategies in patients with CCP.
摘要
背景与目的：
内镜下切除（ER）是一种有效的治疗复杂的结肠息肉（CCP）。许多患者被称为手术切除，因为关注程序的安全性，不完整的息肉切除术，腺瘤复发后的。这两个切除策略的有效性数据是广泛提供的，但缺乏数据存在的成本效益的每一种方式。本研究的目的是进行经济分析比较腹腔镜和腹腔镜切除术（LR）与复杂的结肠息肉治疗策略。
METHODS:
A decision analysis tree was constructed using decision analysis software. The 2 strategies (ER vs LR) were evaluated in a hypothetical cohort of patients with CCPs. A hybrid Markov model with a 10-year time horizon was used. Patients entered the model after colonoscopic diagnosis at age 50. Under Strategy I, patients underwent ER followed by surveillance colonoscopy at 3 to 6 months and 12 months. Patients with failed ER and residual adenoma at 12 months were referred for LR. Under Strategy II, patients underwent LR as primary treatment. Patients with invasive cancer were excluded. Estimates regarding ER performance characteristics were obtained from a systematic review of published literature. The Centers for Medicare & Medicaid Services (2012-2013) and the 2012 Healthcare Cost and Utilization Project databases were used to determine the costs and loss of utility. We assumed that all procedures were performed with anesthesia support, and patients with adverse events in both strategies required inpatient hospitalization. Baseline estimates and costs were varied by using a sensitivity analysis through the ranges.
方法:
利用决策分析软件构建决策分析树。两个策略（二VS LR）是在一个假想的患者CCPs评价。使用了一个10年的时间跨度的混合马尔可夫模型。患者在50岁后的结肠镜诊断模型。在策略I，在3至6个月和12个月的监测结肠镜检查的患者接受了急诊镜检查。失败的患者ER和残余腺瘤12个月被称为LR。在策略二例LR作为主要治疗。有浸润性癌的患者被排除在外。估计雌激素的性能特点，从发表的文献进行了系统的审查。在医疗保险和医疗补助服务中心（2012-2013）和数据库被用来确定成本和效用的损失2012的医疗保健费用和利用项目。我们假设，所有的程序进行麻醉支持，并在这两种策略所需的住院病人的不良事件的患者。基线估计和成本变化，通过使用敏感性分析的范围。
RESULTS:
LR was found to be more costly and yielded fewer quality-adjusted life-years (QALYs) compared with ER. The cost of ER of a CCP was $5570 per patient and yielded 9.640 QALYs. LR of a CCP cost $18,717 per patient and yielded fewer QALYs (9.577). For LR to be more cost-effective, the thresholds of 1-way sensitivity analyses were (1) technical success of ER for complete resection in <75.8% of cases, (2) adverse event rates for ER > 12%, and (3) LR cost of <$14,000.
结果:
LR被发现是更昂贵和产生更少的质量调整生命年（QALY）与ER相比。而复杂的结肠息肉的成本是5570美元每人，产生了9.640个QALYs。LR一中共花费18717美元每人，产生更少的QALYs（9.577）。LR是更具成本效益，对单向敏感性分析的阈值（1）在< 75.8%例完整切除二技术成功，（2）为二> 12%不良事件的发生率（3）和< LR成本14000美元。
CONCLUSIONS:
Our data suggest that ER is a cost-effective strategy for removal of CCPs. The effectiveness is driven by high technical success and low adverse event rates associated with ER, in addition to the increased cost of LR.
结论：
我们的数据表明，ER是去除集中成本领先战略。是有效的技术成功的高和低的不良事件发生率与ER驱动，除了LR的成本增加。
原文：http://www.dxye.com/thread-24304-1-1.html
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