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在一般胃肠病学中优化胃烧的管理算法:成本效益和成本最小化分析
Eric D Shah1, Walter W Chan2, Daniela Jodorkovsky3
1Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan.
使用内镜和反流监测优化胃灼热管理是具有成本效益的. 以表型为指导的治疗,包括在适当时停止使用质子抑制剂 (PPI),可以改善患者的治疗结果,并降低医疗保健成本.
科学领域:
- 胃肠病学 胃肠病学
- 卫生经济学 卫生经济学
- 临床决策建模 临床决策建模
背景情况:
- 胃灼热是胃肠病学实践中普遍存在的症状.
- 需要有效和经济的胃灼热管理策略.
研究的目的:
- 为了优化节烧的成本效益评估和管理.
- 为了比较四个策略,尽管经验性质子抑制剂 (PPI) 治疗患者的持续性胃灼热.
主要方法:
- 通过比较四种管理策略,开发了一种决策分析模型.
- 策略包括PPI优化,PPI优化的内镜,基于发现的PPI中止,以及表型管理的内镜/反流监测.
- 从保险公司和患者的角度评估成本和健康结果,时间跨度为1年,对PPI进行了测试.
主要成果:
- 没有测试的PPI优化是最昂贵的策略.
- 基于内镜的策略改善了健康结果,并降低了与没有测试相比的成本.
- 以表型为导向的管理,包括内镜/健行性反流监测和PPI停止 (如适用) 带来了最大的健康收益 (22天/年健康) 和成本节省.
结论:
- 以患者表型为指导的带有门诊逆流监测的内镜检查提供了具有成本效益的胃灼热管理.
- 对于没有侵蚀性发现的患者,试验停止PPI治疗比继续优化PPI更具成本效益.
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