在一般胃肠病学中优化功能性便秘的成年人管理算法,在纤维/药试验中失败:成本效益和成本最小化分析
Eric D Shah1, Nitin K Ahuja2, Darren M Brenner3
1Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA.
常规的直肠功能测试是管理功能性便秘的成本有效策略. 这种方法有助于将患者分离到适当的治疗方法,如盆地物理治疗,改善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
- 医疗技术评估 医疗技术评估
背景情况:
- 直肠功能测试通常仅限于专门的中心.
- 功能性便秘患者对初始疗法没有反应,需要有效的管理策略.
- 基于办公室的直肠功能测试为分类护理提供了潜在的解决方案.
研究的目的:
- 评估功能性便秘患者的例行直肠功能测试的成本效益.
- 为了比较三个管理策略:经验性的处方药,经验性的骨盆底物理治疗 (PFPT) 和预先的直肠功能测试.
主要方法:
- 从患者的角度进行了成本效益分析,从保险公司的角度进行了成本最小化分析.
- 三种策略进行了比较: (i) 药物然后PFPT, (ii) PFPT然后药物, (iii) 预先直肠功能测试.
- 模型输入来自系统审查,国家成本数据和观察性研究.
主要成果:
- 前期门功能测试是对患者进行适当治疗的最具成本效益的策略.
- 没有交缺陷并有足够的气球驱逐时间的患者被转介到PFPT.
- 经验性PFPT比经验性药物更具成本效益,除非增加肠道运动频率是主要目标.
结论:
- 直肠功能测试是一种新兴的技术,用于优化功能性便秘管理的成本效益.
- 通过直肠功能测试来表型患者护理可以克服测试成本.
- 常规实施可能会导致有效的患者转诊模式,胃肠科医生每年将大约17名患者转诊给PFPT.
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