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预防性剪切与没有剪切后内镜粘膜切除的大型非形结肠多:一个成本效益分析分析

Sneh Sonaiya¹, Raj Patel², Charmy Parikh³

¹Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA.

Gastrointestinal endoscopy

|April 24, 2025

概括

预防性剪切 (PC) 节省了大结肠聚体中延迟的多角切除术后出血的成本,特别是在服用抗血栓剂的患者中. 优化剪贴成本和使用,提高经济可行性.

科学领域:

胃肠病学胃肠病学
卫生经济学卫生经济学
医疗器械技术医疗器械技术

背景情况:

延迟多角切除术后出血 (DPPB) 是一个已知的风险,随着内镜粘膜切除 (EMR) 的大非形结肠聚体 (LNPCPs).
预防性剪切 (PC) 经常用于LNPCP和服用抗血栓剂的患者,但其成本效益仍未得到充分研究.

研究的目的:

评估预防性剪切 (PC) 与不剪切 (NC) 的成本效益,以预防LNPCP的EMR后的DPPB.
确定PC的经济影响在不同的多大小和患者风险因素,包括抗血栓使用.

主要方法:

使用马尔科夫决策树模型进行了增量成本效益分析.
数据是从随机对照试验中汇总的,成本来自CMS补偿数据和文献.
分析考虑了1年的时间视野,并使用了TreeAge Pro Healthcare 2024软件.

主要成果:

对于一个65岁的患者,近端LNPCP≥20毫米,PC节省了成本 (ICER:-154,706美元).
对于非常大的 (≥40毫米) LNPCP (ICER: 83,894美元),PC是具有成本效益的.
对于接受抗血栓治疗的患者来说,PC可以节省高达2个剪辑的成本 (ICER:-120,561美元).

结论:

预防性剪切对于近端LNPCP和服用抗血栓剂的患者来说是节省成本的,对于100,000美元/QALY值的非常大的LNPCP来说是成本有效的.
将剪贴成本降低至≤217美元或将使用限制至≤4个剪贴提高了PC的经济可行性.
这些发现支持PC的战略性使用,以管理与LNPCP的EMR相关的出血风险和成本.

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