Early health economic modelling of single-stage cartilage repair. Guiding implementation of technologies in regenerative medicine
Early health economic modelling of single-stage cartilage repair. Guiding implementation of technologies in regenerative medicine
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DOI：
10.1002/term.2197
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发表时间：
2017-10-01
影响因子：
3.3
通讯作者：
Saris, Daniel B. F.
中科院分区：
文献类型：
--
作者：
de Windt, Tommy S.;Sorel, Juliette C.;Saris, Daniel B. F.
关节软骨修复的临床应用组织工程技术的复杂性-如自体软骨细胞植入（ACI）-加上不断增加的医疗成本和市场竞争，迫使重点从两阶段转移到更具成本效益的单阶段干预。早期的卫生经济模型有望在新干预措施被引入临床实践之前，为推动其成本效益的参数提供必要的见解。本研究估计了一种新的微骨折驱动单阶段手术（IMPACT）与微骨折和ACI相比可能的增量成本效益比（ICER），并确定了影响成本效益的参数。构建了一个具有临床健康状态的决策树。ICER的计算方法是将增量社会成本除以增量质量调整生命年（QALY）。成本是从社会的角度来确定的。进行净空分析，以确定与ACI和微骨折相比IMPACT的最高价格，假设社会支付意愿（WTP）为（原文如此）30 000/QALY。进行了单向敏感性分析，以确定驱动成本效益的参数。IMPACT、ACI和微骨折的社会成本分别为11797、29741和6081。IMPACT后所有效用增加8%，IMPACT与微骨折的ICER从（原文如此）147 513/QALY变为（原文如此）28 588/QALY。与ACI相比，IMPACT成本较低，这主要归因于细胞扩增程序已变得多余。虽然微骨折可以被认为是较小缺损的最具成本效益的治疗选择，但单阶段组织工程手术可以取代ACI，以提高治疗较大缺损的成本效益，特别是如果可以实现临床非劣效性。版权所有（C）2016约翰威利父子有限公司
Both the complexity of clinically applied tissue engineering techniques for articular cartilage repair - such as autologous chondrocyte implantation (ACI) - plus increasing healthcare costs, and market competition, are forcing a shift in focus from two-stage to single-stage interventions that are more cost-effective. Early health economic models are expected to provide essential insight in the parameters driving the cost-effectiveness of new interventions before they are introduced into clinical practice. The present study estimated the likely incremental cost-effectiveness ratio (ICER) of a new investigator-driven single-stage procedure (IMPACT) compared with both microfracture and ACI, and identified those parameters that affect the cost-effectiveness. A decision tree with clinical health states was constructed. The ICER was calculated by dividing the incremental societal costs by the incremental Quality Adjusted Life Years (QALYs). Costs were determined from a societal perspective. A headroom analysis was performed to determine the maximum price of IMPACT compared with both ACI and microfracture, assuming a societal willingness to pay (WTP) of (sic)30 000/QALY. One-way sensitivity analysis was performed to identify those parameters that drive the cost-effectiveness. The societal costs of IMPACT, ACI and microfracture were found to be (sic)11 797, (sic)29 741 and (sic) 6081, respectively. An 8% increase in all utilities after IMPACT changes the ICER of IMPACT vs. microfracture from (sic)147 513/QALY to (sic) 28 588/QALY. Compared with ACI, IMPACT is less costly, which is largely attributable to the cell expansion procedure that has been rendered redundant. While microfracture can be considered the most cost-effective treatment option for smaller defects, a single-stage tissue engineering procedure can replace ACI to improve the cost-effectiveness for treating larger defects, especially if clinical non-inferiority can be achieved. Copyright (C) 2016 John Wiley & Sons, Ltd.