Clinical and economic outcomes of individuals with severe peptic ulcer hemorrhage and nonbleeding visible vessel: an analysis of two prospective clinical trials.
Clinical and economic outcomes of individuals with severe peptic ulcer hemorrhage and nonbleeding visible vessel: an analysis of two prospective clinical trials.
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患有严重消化性溃疡出血和不出血可见血管的个体的临床和经济结果：两项前瞻性临床试验的分析。
DOI：
10.1111/j.1572-0241.1998.00590.x
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Sue,M
中科院分区：
文献类型：
--
作者：
Gralnek,IM;Jensen,DM;Gornbein,J;Kovacs,TO;Jutabha,R;Freeman,ML;King,J;Jensen,ME;Cheng,S;Machicado,GA;Smith,JA;Randall,GM;Sue,M
目的：我们报告了 155 例急诊内镜检查时出现严重消化性溃疡出血且未出血可见血管的患者接受内镜止血或药物手术治疗的临床结果和直接医疗费用。方法：在两项连续的前瞻性、随机对照试验中，患者被随机分配接受内镜止血（加热探针、双极电凝或注射硬化）或药物手术治疗。研究终点包括严重溃疡再出血和紧急手术的发生率、住院时间、输血需求、死亡率和利用医疗保健的直接费用。使用消耗资源的固定和可变机构成本和医疗保险报销率相结合来估计直接医疗成本。结果：与药物手术治疗相比，内窥镜治疗患者的严重溃疡再出血率（p = 0.004）、急诊手术率（p = 0.002和p = 0.019、0.024）和输血率（p = 0.025）显着降低。在多变量模型中观察到的溃疡再出血率的试验间差异可以部分地通过共病疾病和住院溃疡出血的协变量来解释。在这两项试验中，住院时间、死亡率和治疗相关并发症相似。每个患者的估计中位直接成本有所不同：第一项试验的内窥镜止血成本较低（4254 美元，电凝治疗为 4620 美元，内科手术治疗为 5909 美元），但第二项试验的内科手术治疗成本较低（注射硬化为 3169 美元，注射硬化为 3477 美元，加热探针为 4098 美元）。结论：与内科手术治疗相比，内镜下止血治疗严重溃疡出血和不出血的可见血管可显着改善患者预后，并且是安全的。该程序可能会或可能不会降低直接医疗费用和节省成本。
Objective:We report the clinical outcomes and direct medical costs of 155 patients with severe peptic ulcer hemorrhage and a nonbleeding visible vessel at emergency endoscopy treated with endoscopic hemostasis or medical-surgical therapy.Methods:In two consecutive, prospective, randomized, controlled trials, patients were randomly assigned to endoscopic hemostasis (heater probe, bipolar electrocoagulation, or injection sclerosis) or medical-surgical treatment. Study endpoints included the incidence of severe ulcer rebleeding and emergency surgery, length of hospital stay, blood transfusion requirements, mortality rate, and direct costs of utilized health care. Direct medical costs were estimated using combined fixed and variable institutional costs for consumed resources and Medicare reimbursement rates.Results:Compared with medical-surgical treatment, endoscopically treated patients had significantly lower rates of severe ulcer rebleeding (p= 0.004), emergency surgery (p= 0.002 and p= 0.019, 0.024), and blood transfusions (p= 0.025). Observed inter-trial differences in ulcer rebleeding rates may be partially explained in a multivariate model by covariates of comorbid disease and inpatient ulcer bleeding. In both trials, length of hospital stay, mortality rates, and treatment-related complications were similar. Estimated median direct costs per patient differed: The first trial had lower costs with endoscopic hemostasis ($4254, vs $4620 for electrocoagulation and $5909 for medical-surgical treatment), yet the second trial yielded lower costs with medical-surgical treatment ($3169, vs $3477 for injection sclerosis and $4098 for heater probe).Conclusions:Compared with medical-surgical therapy, endoscopic hemostasis for severe ulcer hemorrhage and a nonbleeding visible vessel yielded significantly better patient outcomes and was safe. This procedure may or may not yield lower direct medical costs and cost savings.