高流量,以更高的成本? 一项试点研究比较了Moyamoya疾病的直接与间接绕道,使用基于时间驱动的活动成本计算
Advith Sarikonda1, Danyal Quraishi2, Arbaz Momin2
1Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.
概括
对莫亚莫亚病 (MMD) 的直接绕道 (DB) 手术比间接绕道 (IB) 手术更昂贵,主要是由于供应成本更高. 这一发现可以为手术决策和用于MMD治疗的资源分配提供信息.
科学领域:
- 神经外科 神经外科
- 卫生经济学 卫生经济学
背景情况:
- 莫亚莫亚病 (MMD) 管理涉及直接绕道 (DB) 和间接绕道 (IB) 的成本影响尚不清楚.
- 成本是影响成年MMD手术选择的重要因素.
研究的目的:
- 为了比较成人moyamoya病的DB与IB的内科手术成本.
- 通过基于时间驱动的活动成本计算 (TDABC) 识别特定的成本驱动因素.
主要方法:
- 对38名接受再血管化治疗的MMD成年患者进行回顾性队列研究 (2017-2022).
- 基于时间驱动的基于活动的成本计算 (TDABC) 计算了手术内供应和人员成本.
- 多变量回归分析了DB和IB之间的成本差异,并调整了患者因素.
主要成果:
- 直接绕道 (DB) 手术的中位数总成本为7,802美元,而间接绕道 (IB) 的成本为6,120美元 (p <0.05).
- 由于消耗品和植入物,DB的供应成本显著增加 (3793美元与2855美元相比,p < 0.01),主要是消耗品和植入物.
- 多变量分析证实,DB与更高的总成本 (β:1,758美元,p=0.027) 和供应成本 (β:1,032美元,p=0.004) 有关.
结论:
- 由于供应支出较高,对莫亚莫亚病 (MMD) 的直接绕道 (DB) 手术比间接绕道 (IB) 更昂贵.
- TDABC方法提供了对MMD再血管化的成本驱动因素的细粒度洞察力.
- 结果可以指导手术决策,机构预算和对MMD治疗资源优化.
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