针对内动脉瘤的全人口查的成本效益性根据潜在的诊断发展而重新审视
Michael Veldeman1, Oliver Schoeffski2, Anke Hoellig1
1Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany.
概括
对于未破裂的内动脉瘤 (UIAs) 的全人口查不太可能具有成本效益,即使使用新的血液检测. 未来的成本削减可能会使查在卫生政策决策中变得更加可行.
科学领域:
- 神经学 神经学
- 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:
- 预防性治疗未破裂的内动脉瘤 (UIAs) 可能会降低下关节出血 (SAH) 的发生率.
- 由于对低风险动脉瘤的管理不确定性,目前不考虑对UIA进行全人口查 (PWS).
- 新兴的UIA基于血液的查测试可能为未来的PWS提供了可能性.
研究的目的:
- 确定假设UIA查测试的健康经济标准,以证明PWS.
- 评估PWS与UIA标准护理相比的成本效益.
主要方法:
- 开发了一个马尔科夫模型来比较PWS与标准护理.
- 来自RWTH Aachen大学医院的现实世界数据,包括SAH和UIA数据库,用于模型参数化.
- 进行了增量成本效益比率 (ICER) 和灵敏度分析,以根据支付意愿 (WTP) 评估成本效益.
主要成果:
- 由于每次QALY的WTP为50,000欧元,一个高达225.72欧元的查测试可能仍然具有成本效益.
- 如果该测试还有助于低风险患者的警等待,则其可接受的成本增加到294.19欧元.
- 没有确定PWS成为主导 (负ICER) 的价格点.
结论:
- 随着目前的技术,对UIA进行全人口查不太可能具有成本效益.
- 对于卫生政策制定者来说,PWS的成本效益可能会提高,如果在专利到期后查测试成本大幅下降.
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