Patient-level costs in margin re-excision for breast-conserving surgery
Patient-level costs in margin re-excision for breast-conserving surgery
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DOI：
10.1002/bjs.11050
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发表时间：
2019-03-01
影响因子：
9.6
通讯作者：
Leff, D. R.
中科院分区：
文献类型：
--
作者：
Grant, Y.;Al-Khudairi, R.;Leff, D. R.
背景：保乳手术（BCS）后的高再手术率与医疗保健提供者的成本相关。目的是评估报告的再切除成本的证据质量，并比较成功BCS患者与BCS后再手术患者之间的直接患者水平成本。方法：该研究使用了2015年4月至2016年3月在同一机构接受或未接受再手术的BCS患者的数据。对BCS的卫生经济分析进行了系统回顾，并使用卫生经济研究质量（QHES）工具进行了评分。使用患者级信息和成本系统（PLICS）检索患者的财务数据。使用的汇率是：1美元= 0.75英镑，1英镑= 1.14英镑，1美元= 0.85英镑。结果：QHES评分中位数为47分（i.q.r 32.5-79）。九项研究中只有两项在QHES的四分位数上得分（得分至少为75分）。最初的乳房肿瘤切除术和再次手术的费用分别在1234-11786美元和655-9136美元之间。在12个月的时间间隔中，153例患者确诊BCS， 59例患者再次手术。BCS（59例）后再手术的中位费用为4511英镑（范围1752-18019），与未再手术的BCS相比，每例患者额外增加2136英镑（P < 0.001）。结论：系统评价表明成本估算方法存在差异，缺乏高质量的再手术成本估算研究。将当地的PLICS数据外推到国家层面表明，第一次正确使用BCS可以节省大量资金。
Background: High rates of reoperation following breast-conserving surgery (BCS) for positive margins are associated with costs to healthcare providers. The aim was to assess the quality of evidence on reported re-excision costs and compare the direct patient-level costs between patients undergoing successful BCS versus reoperations after BCS.Methods: The study used data from women who had BCS with or without reoperation at a single institution between April 2015 and March 2016. A systematic review of health economic analysis in BCS was conducted and scored using the Quality of Health Economic Studies (QHES) instrument. Financial data were retrieved using the Patient-Level Information and Costing Systems (PLICS) for patients. Exchange rates used were: US $1 = 0.75 pound, 1 pound = (sic)1.14 and US $1 = (sic)0.85.Results: The median QHES score was 47 (i.q.r. 32.5-79). Only two of nine studies scored in the upper QHES quartile (score at least 75). Costs of initial lumpectomy and reoperation were in the range US$ 1234-11786 and $655-9136 respectively. Over a 12-month interval, 153 patients had definitive BCS and 59 patients underwent reoperation. The median cost of reoperations after BCS (59 patients) was 4511 pound (range 1752-18019), representing an additional 2136 pound per patient compared with BCS without reoperation (P < 0.001).Conclusion: The systematic review demonstrated variation in methodological approach to cost estimates and a paucity of high-quality cost estimate studies for reoperations. Extrapolating local PLICS data to a national level suggests that getting BCS right first time could result in substantial savings.