Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan.
Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan.
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DOI：
10.1186/s13017-020-00344-x
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发表时间：
2021-01-07
期刊：
影响因子：
--
通讯作者：
Fujimi S
中科院分区：
文献类型：
--
作者：
Kinoshita T;Moriwaki K;Hanaki N;Kitamura T;Yamakawa K;Fukuda T;Hunink MGM;Fujimi S
混合急诊室(ER)系统，由创伤复苏室内的血管造影-计算机断层扫描(CT)机器组成，据报道对减少创伤患者因失血而死亡是有效的。我们旨在研究混合式急救系统在无严重颅脑损伤(TBI)的严重创伤患者中的成本-效果。我们从日本第三方医疗支付方的角度对混合型ER系统和传统ER系统进行了成本效用分析。构建了一个短期决策树和一个使用终身时间范围的长期马尔可夫模型来估计质量调整寿命年(QALY)和相关的终身医疗成本。短期死亡率和医疗保健成本是根据具有混合急诊室的三级护理医院的医疗记录和索赔数据得出的。长期死亡率和效用从文献中推断出来。支付意愿门槛设定为每增加一个QALY支付47,619美元，贴现率为2%。进行了确定性和概率敏感性分析。与传统ER系统相比，混合ER系统增加了1.03 QALY，寿命成本增加了33,591美元，导致每QALY获得32,522美元的ICER。如果28天死亡率的优势比为0.66，ICER低于支付意愿阈值。概率灵敏度分析表明，混合ER系统具有79.3%的概率，是经济有效的。本研究表明，对于无严重脑外伤的严重创伤患者，混合式急救系统可能是一种经济有效的治疗策略。
Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.
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影响因子：
168.9
作者：
Huber-Wagner, Stefan;Lefering, Rolf;Kanz, Karl-Georg
通讯作者：
Kanz, Karl-Georg
影响因子：
4.5
作者：
Siebert, Uwe;Alagoz, Oguzhan;Kuntz, Karen M.
通讯作者：
Kuntz, Karen M.
DOI：
10.1093/geronb/gbp012
发表时间：
2009-05-01
影响因子：
6.2
作者：
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通讯作者：
Fryback, Dennis G.
影响因子：
9.6
作者：
Saltzherr, T. P.;Bakker, F. C.;Goslings, J. C.
通讯作者：
Goslings, J. C.
影响因子：
2.1
作者：
Hayashida, Kei;Kinoshita, Takahiro;Fujimi, Satoshi
通讯作者：
Fujimi, Satoshi