Cost-effectiveness of anterotemporal lobectomy in medically intractable complex partial epilepsy
Cost-effectiveness of anterotemporal lobectomy in medically intractable complex partial epilepsy
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DOI：
10.1111/j.1528-1157.1997.tb01091.x
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发表时间：
1997-02-01
期刊：
影响因子：
5.6
通讯作者：
Langfitt, JT
中科院分区：
文献类型：
--
作者：
Langfitt, JT
目的：高成本卫生技术的价值越来越受到卫生保健提供者的审查。高科技癫痫护理的成本和结果的理解是必要的，以确保有效的resource allocation.Methods：决策分析被用来估计前颞叶切除术（ATL）的成本效益相比，标准的医疗管理在医学上难治性癫痫。当地（美国纽约州罗切斯特）成本数据被应用到一个模型的终身折扣成本和结果的评估，ATL，并在一个假设的队列patients.Results后续：基础病例分析得出的边际成本效果比（MECR）为15,581美元/质量调整生命年（QALY）。广泛的敏感性分析确定的极端条件下，ATL的评价是占主导地位的（更有效，成本更低），或在其中它可能被认为是不值得的成本（MCER > 50,000美元/QALY）。结论：ATL的成本效益的估计属于一个普遍可接受的范围内，即使考虑到许多模型参数的不确定性。根据文献中现有数据的假设，ATL的成本效益与其他健康技术相比毫不逊色。前瞻性多中心研究的区域成本和实践的变化，癫痫发作结局状态之间的年到年的转换及其对生活质量（QOL）的影响的长期概率，以及非手术治疗对癫痫发作控制和QOL的影响，需要提供关键数据来确认和约束这些估计。
Purpose: The value of high-cost health technologies is being increasingly scrutinized by providers of health care. An understanding of the costs and outcomes of high-technology epilepsy care is required to ensure efficient resource allocation.Methods: Decision analysis was used to estimate the cost effectiveness of anterotemporal lobectomy (ATL) as compared with standard medical management in medically-intractable epilepsy. Local (Rochester, NY, U.S.A.) cost data were applied to a model of lifetime discounted costs and outcomes of evaluation, ATL, and follow-up in a hypothetical cohort of patients.Results: Base case analysis yielded a marginal cost-effectiveness ratio (MECR) of $15,581/quality-adjusted life year (QALY). Extensive sensitivity analyses identified extreme conditions in which evaluation for ATL was dominant (more effective and less costly) or in which it might be considered not worth the cost (MCER >$50,000/QALY).Conclusions: Estimates of ATL cost effectiveness fall within a generally acceptable range, even when uncertainty about many model parameters is taken into account. Under assumptions based on available data in the literature, the cost effectiveness of ATL compares favorably with that of other health technologies. Prospective multicenter studies of regional cost and practice variations; long-term probabilities of year-to-year transitions between seizure outcome states and their effects on quality of life (QOL), and the effect of nonsurgical treatments on seizure control and QOL are needed to provide the critical data to confirm and constrain these estimates.