同时双边皮肤穿透性髓切除术:它是否具有成本效益?
Gillian Murray1, Austen Slade2, Ben Johnson2
1Mayo Clinic Rochester, Department of Urology, Rochester, MN.
Urology
|February 27, 2025
概括
同时双边皮肤穿神经切除术 (PCNL) 对于大型双边结石来说,比分阶段PCNL更具成本效益和有效性. 这种方法在一年内以更低的成本提供了更好的结果.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 卫生经济学 卫生经济学
- 腎石病的管理方法
背景情况:
- 大型双边结石会带来复杂的治疗挑战.
- 穿皮瘤切除术 (PCNL) 是一种主要的治疗方式.
- 对比同步与分阶段的方法对于优化患者护理和资源配置至关重要.
研究的目的:
- 为了评估同时与分阶段PCNL对患有大,双边石负担的患者的成本效益.
- 为了比较临床结果,包括无石头率和质量调整后生命年 (QALYs).
主要方法:
- 使用决策分析的马尔科夫模型来模拟成本和结果.
- 关于手术费用,手术时间和停留时间的数据来自一个大型的单中心队列.
- 医疗保险成本和QALY是主要结果指标,支付意愿的门为10万美元/QALY.
主要成果:
- 同时PCNL的成本较低 (52,585美元) 与分阶段PCNL (61,687美元) 相比,在一年内.
- 同时的PCNL产生更高的QALY (0.982) 比分阶段的PCNL (0.977).
- 阶段性PCNL只有在特定条件下才具有成本效益,例如88%的无石头率或单方面PCNL成本的显著降低.
结论:
- 同时的双边PCNL被证明比在一年内分阶段的双边PCNL更便宜,更有效.
- 这一发现即使假设同时方法的无石头率略有降低和并发症率增加,也是如此.
- 结果支持在适当的临床场景中同时使用双边PCNL来管理大型双边结石.
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