在心脏手术中进行手术内神经监测的成本效益分析
Bhav Jain1, Faraan O Rahim2, Parthasarathy D Thirumala3
1Stanford University School of Medicine, Stanford, CA, United States; Massachusetts Institute of Technology, Cambridge, MA, United States.
概括
术内神经监测 (IONM) 通过预防神经并发症,为高风险患者在心脏手术期间提供了显著的成本节省. 这一分析支持IONM的观点.
科学领域:
- 心血管外科心血管外科
- 神经学 神经学
- 卫生经济学 卫生经济学
背景情况:
- 术内神经监测 (IONM) 是一种实时工具,用于在手术过程中检测大血管封闭 (LVO).
- 神经学并发症,通常源于外科手术期间的LVO,对接受心脏手术的患者构成重大风险.
研究的目的:
- 在接受心脏手术的患者中实施IONM进行全面的成本效益分析.
- 评估IONM在预防与LVO相关的神经缺陷方面的经济影响.
主要方法:
- 使用马尔科夫节点的决策分析树模拟了65岁心脏手术患者的功能结果 (修改的兰金尺度).
- 该分析比较了IONM (脑电图和体感官唤起潜力) 的终身成本与美国没有IONM从社会角度来看.
- 进行了基准案例和单向概率灵敏度分析,以评估研究结果的稳定性.
主要成果:
- 在0.31%的基线LVO率下,IONM与未监测的手术相比,终身支出增加了1047.41美元.
- 确定了约3.67%的临界LVO率,在此以上,IONM实施变得节省成本.
- 敏感性分析表明,IONM对高风险患者来说是节省成本的,而LVO率是最有影响力的因素.
结论:
- IONM在心脏外科手术中节省了相当大的成本,特别是在高风险患者群体中.
- 这些发现为决策者,临床医生和患者提供了关于IONM利用的宝贵财务见解.
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