Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis.
Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis.
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DOI：
10.1002/lary.24916
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发表时间：
2015-01
期刊：
影响因子：
2.6
通讯作者：
Smith, Timothy L.
中科院分区：
文献类型：
--
作者：
Rudmik, Luke;Soler, Zachary M.;Mace, Jess C.;Schlosser, Rodney J.;Smith, Timothy L.
关键词：
评估内窥镜鼻窦手术 (ESS) 与持续药物治疗相比对难治性慢性鼻窦炎 (CRS) 患者的长期成本效益。队列式马尔可夫决策树经济评估 经济视角是美国第三方付款人，时间跨度为 30 年。两种比较治疗策略是：1) ESS 后进行适当的术后药物治疗；2) 继续单独进行药物治疗。主要结果是每个质量调整生命年（QALY）的增量成本。在参考案例中，成本按 3.5% 的比率贴现。进行了多重敏感性分析，包括不同的时间范围、贴现情景和概率敏感性分析（PSA）。参考案例表明，ESS 策略总共花费了 48,838.38 美元，总共产生了 20.50 个 QALY。仅药物治疗策略总共花费 28,948.98 美元，总共产生 17.13 QALY。 ESS 与单独药物治疗相比的增量成本效益比 (ICER) 为每 QALY 5,901.90 美元。 PSA 的成本效益可接受性曲线表明，对于任何支付门槛高于 25,000 美元的意愿，ESS 策略有 74% 的确定性是最具成本效益的决策。时间范围分析表明，ESS 在术后第 3 年内成为具有成本效益的干预措施。这项研究的结果表明，对于难治性 CRS 患者的长期管理，与单独继续药物治疗相比，采用 ESS 治疗策略是最具成本效益的干预措施。
To evaluate the long-term cost-effectiveness of endoscopic sinus surgery (ESS) compared to continued medical therapy for patients with refractory chronic rhinosinusitis (CRS). Cohort-style Markov decision tree economic evaluation The economic perspective was the US third party payer with a 30 year time horizon. The two comparative treatment strategies were: 1) ESS followed by appropriate postoperative medical therapy and 2) continued medical therapy alone. Primary outcome was the incremental cost per quality adjusted life year (QALY). Costs were discounted at a rate of 3.5% in the reference case. Multiple sensitivity analyses were performed including differing time-horizons, discounting scenarios, and a probabilistic sensitivity analysis (PSA). The reference case demonstrated that the ESS strategy cost a total of $48,838.38 and produced a total of 20.50 QALYs. The medical therapy alone strategy cost a total of $28,948.98 and produced a total of 17.13 QALYs. The incremental cost effectiveness ratio (ICER) for ESS versus medical therapy alone is $5,901.90 per QALY. The cost-effectiveness acceptability curve from the PSA demonstrated that there is 74% certainty that the ESS strategy is the most cost-effective decision for any willingness to pay threshold greater then $25,000. The time horizon analysis suggests that ESS becomes the cost-effective intervention within the 3rd year after surgery. Results from this study suggest that employing an ESS treatment strategy is the most cost-effective intervention compared to continued medical therapy alone for the long-term management of patients with refractory CRS.
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影响因子：
7.2
作者：
Fokkens, Wytske J.;Lund, Valerie J.;Zwetsloot, Casper P.
通讯作者：
Zwetsloot, Casper P.
影响因子：
3.6
作者：
BLACK, WC
通讯作者：
BLACK, WC
影响因子：
3.4
作者：
Bhattacharyya, Neil;Orlandi, Richard R.;Martinson, Melissa
通讯作者：
Martinson, Melissa
影响因子：
6.4
作者：
Au, Jennifer;Rudmik, Luke
通讯作者：
Rudmik, Luke
影响因子：
2.6
作者：
Rudmik, Luke;Smith, Timothy L.;Schlosser, Rodney J.;Hwang, Peter H.;Mace, Jess C.;Soler, Zachary M.
通讯作者：
Soler, Zachary M.