Long-Term Percutaneous Nephrostomy Management of Malignant Urinary Obstruction: Estimation of Optimal Exchange Frequency and Estimation of the Financial Impact of Patient Compliance
Long-Term Percutaneous Nephrostomy Management of Malignant Urinary Obstruction: Estimation of Optimal Exchange Frequency and Estimation of the Financial Impact of Patient Compliance
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DOI：
10.1016/1.jvir.2017.02.031
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发表时间：
2017-07-01
影响因子：
2.9
通讯作者：
Pillai, Anil K.
中科院分区：
文献类型：
--
作者：
McDevitt, Joseph L.;Acosta-Torres, Stefany;Pillai, Anil K.
目的：估计最便宜的常规交换频率为经皮肾造口术（PCNs）放置恶性尿路梗阻，每年的医院收费，并估计患者compliance.Materials和方法的财务影响放置恶性尿路梗阻PCNs患者进行了研究，从2011年至2013年。交换被归类为常规或由于3种并发症类型中的1种：机械性（管子脱位）、阻塞或感染。确定了代表性案例，并将代表性费用的中位数用作模型的输入。加速失效时间和马尔可夫链蒙特卡罗模型被用来估计分布的交换类型和每年的医院费用在不同的常规交换频率和遵守scenaries.Results：长期PCN管理需要在57例患者，与87总交换遭遇。肾盂肾炎和梗阻的中位代表性医院费用分别是常规交换的11.8倍和9.3倍。当从90天交换（50%依从性）变为60天交换（75%依从性）时，常规交换的预计比例增加，感染相关交换的预计比例降低，这与预计年费降低有关。预计成本降低，从而增加遵守一般大于减少导致的变化，在交流frequency.Conclusions：该模拟模型表明，最佳的常规交换间隔PCN交换恶性尿路梗阻患者约60天，收费的程度减少可能更多地取决于患者的依从性比确切的交换间隔。
Purpose: To estimate the least costly routine exchange frequency for percutaneous nephrostomies (PCNs) placed for malignant urinary obstruction, as measured by annual hospital charges, and to estimate the financial impact of patient compliance.Materials and Methods: Patients with PCNs placed for malignant urinary obstruction were studied from 2011 to 2013. Exchanges were classified as routine or due to 1 of 3 complication types: mechanical (tube dislodgment), obstruction, or infection. Representative cases were identified, and median representative charges were used as inputs for the model. Accelerated failure time and Markov chain Monte Carlo models were used to estimate distribution of exchange types and annual hospital charges under different routine exchange frequency and compliance scenarios.Results: Long-term PCN management was required in 57 patients, with 87 total exchange encounters. Median representative hospital charges for pyelonephritis and obstruction were 11.8 and 9.3 times greater, respectively, than a routine exchange. The projected proportion of routine exchanges increased and the projected proportion of infection-related exchanges decreased when moving from a 90-day exchange with 50% compliance to a 60-day exchange with 75% compliance, and this was associated with a projected reduction in annual charges. Projected cost reductions resulting from increased compliance were generally greater than reductions resulting from changes in exchange frequency.Conclusions: This simulation model suggests that the optimal routine exchange interval for PCN exchange in patients with malignant urinary obstruction is approximately 60 days and that the degree of reduction in charges likely depends more on patient compliance than exact exchange interval.