Cost-effectiveness of laparoscopic versus open appendectomy in developing nations: a Colombian analysis
Cost-effectiveness of laparoscopic versus open appendectomy in developing nations: a Colombian analysis
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DOI：
10.1016/j.jss.2017.11.007
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发表时间：
2018-04-01
影响因子：
2.2
通讯作者：
Rugeles, Saul
中科院分区：
文献类型：
--
作者：
Ruiz-Patino, Alejandro;Rey, Samuel;Rugeles, Saul
背景：哥伦比亚是一个发展中国家，需要在不断创新的保健等领域进行有效的资源管理。自从引入腹腔镜阑尾切除术（LA）以来，直接成本一直在增加，但临床结局方面没有明确的结果。本研究的目的是确定开放式阑尾切除术（OA）与LA的成本效益，从而帮助外科医生在有限的资源setting.Methods的临床决策：一项回顾性的成本效益分析比较OA与多端口LA在2013年在哥伦比亚波哥大的三级大学医院（圣伊格纳西奥大学医院）进行。有效性被确定为因并发症而节省的额外住院时间（LOS）天数。作者共收集了377份临床病史，并分析了以下变量：手术类型、转为开腹手术、并发症（手术部位感染、再次介入和再次入院）、医院LOS以及初次手术和后续并发症相关住院的总住院费用。估计OA和LA加并发症的总累积成本和LOS。成本效益阈值定为46美元（139，000哥伦比亚比索[COP]），即在海洋法法庭增加一天的费用。增量成本效果比计算为OA作为比较和LA作为intervention.Results：LA的数量为130和OA为247。这两个群体在人口特征方面是平衡的。并发症发生率OA组为13.7%，LA组为10.4%（P < 0.05），LOS均为2d（P = 0.9）。未记录从LA转为OA。OA并发症的总成本为8523美元（25，569，220 COP），LA为3385美元（10，157，758 COP）。包括手术和并发症费用以及OA的LOS在内的累积费用分别为65，753美元（197，259，310 COP）和297美元。同样，法律事务分别为66，425美元（199，276，948缔约方会议）和271美元。增量成本-效果比为25.86美元（77，601 COP），使LA成为成本-效果的替代方案，成本-效果阈值下的差异为20.76美元（62，299 COP）。结论：LA是一种成本-效果优于OA的替代方案，由于并发症节省，每天额外住院费用增加25.85美元。这说明了哥伦比亚等发展中国家手术干预和并发症的低成本。(C)2017爱思唯尔公司All rights reserved.
Background: Colombia is a developing nation in need for efficient resource administration in fields such as health care, where innovation is constant. Since the introduction of laparoscopic appendectomy (LA), direct costs have been increasing without definitive results in terms of clinical outcomes. The objective of this study is to determine the cost-effectiveness of open appendectomy (OA) versus LA and thereby help surgeons in clinical decision-making in a limited resource setting.Methods: A retrospective cost-effectiveness analysis comparing OA versus multiport LA during 2013 in a third-level university hospital (Hospital Universitario San Ignacio) in Bogota, Colombia was performed. Effectiveness was determined as the number of days in additional length of stay (LOS) due to the complications saved. A total of 377 clinical histories were collected by the authors and analyzed for the following variables: surgery type, conversion to open laparotomy, complications (surgical site infection, reintervention, and readmission), hospital LOS, and total cost of hospitalization for initial surgery and subsequent complications-related hospitalizations. The total accumulative costs and LOS for OA and LA plus complications were estimated. The cost-effectiveness threshold was set at US $46 (139,000 Colombian Peso [COP]), the cost of an additional day in LOS. An incremental cost-effectiveness ratio was calculated for OA as the comparator and LA as the intervention.Results: The number of LA was 130 and of OA was 247. The two groups were balanced in terms of population characteristics. Complication rate was 13.7 % for OA and 10.4% for LA (P < 0.05), and LOS was 2 days for LA and OA (P = 0.9). No conversions from LA to OA were recorded. The total costs for complications for OA were US $8523 (25,569,220 COP) and US 3385 (10,157,758 COP) for LA. Cumulative costs including cost of surgery and complications and LOS for OA were US $65,753 (197,259,310 COP) and 297, respectively. Similarly, for LA were US $66,425 (199,276,948 COP) and 271, respectively. The incremental cost-effectiveness ratio was US $25.86 (77,601 COP) making LA a cost-effective alternative with a difference of US $20.76 (62,299 COP) under the cost-effectiveness threshold.Conclusions: LA is a cost-effective alternative over OA with an increasing cost of $25.85 per day of additional hospitalization due to complications saved. This is accounting the low cost of surgical interventions and complications in developing nations such as Colombia. (C) 2017 Elsevier Inc. All rights reserved.