What is the cost of endoscopic submucosal dissection (ESD)? A medico-economic study
What is the cost of endoscopic submucosal dissection (ESD)? A medico-economic study
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DOI：
10.1177/2050640618810572
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发表时间：
2019-02-01
影响因子：
6
通讯作者：
Jacques, Jeremie
中科院分区：
文献类型：
--
作者：
Dahan, Martin;Pauliat, Emmanuelle;Jacques, Jeremie
前言：内窥镜下黏膜下剥离术(ESD)是治疗消化道浅表病变的金标准。欧洲还没有进行过医学经济学研究。材料与方法采用单中心研究，纳入2015年1月至2017年12月期间所有接受ESD治疗的患者。全球住院费用是通过微观成本计算来衡量的，收入是基于诊断相关组(DRG)系统的。主要目标是评估成本/收入平衡。作为次要结果，进行了与手术的医学经济学比较。结果共193例患者纳入前瞻性研究。每次手术的成本是3463.79欧元，从2726.84欧元的收入中减去，每次入住的赤字为736.96欧元。在多变量分析中，存在合并症/并发症增加的DRG值是正预算平衡的唯一预测因素(优势比49.21，95%可信区间11.3-214.25，p<；0.0001)。与手术相比，ESD的住院时间更短(11比2天；p<；0.0001)，发病率更低(28%比14%；p=0.061)，费用更低(8960欧元比1770欧元；p<；0.0001)。结论80%的病例ESD成本/收益为负值。鉴于ESD在患者发病率方面的好处以及与手术相比节省的经济成本，实施特定的ESD报销是有必要的。
Introduction Endoscopic submucosal dissection (ESD) is the gold-standard treatment for superficial lesions of the digestive tract. No medico-economic study has been conducted in Europe. Material and methods A monocentric study was conducted including all patients undergoing ESD between January 2015 and December 2017. The global cost of hospital stays was measured by microcosting, and revenue was based on the diagnosis-related group (DRG) system. The primary objective was to assess the cost/revenue balance. A medico-economic comparison with surgery was performed as a secondary outcome. Results A total of 193 patients were prospectively included. The cost per procedure was euro3463.79, subtracted from a euro2726.84 revenue, with a deficit of -euro736.96 per stay. Presence of comorbidities/complications increasing DRG value was the only predictive factor for a positive budgetary balance in a multivariate analysis (odds ratio 49.21, 95% confidence interval 11.3-214.25, p < 0.0001). In comparison with surgery, ESD was associated with shorter length of stay (11 vs 2 days; p < 0.0001) and lower morbidity (28% vs 14%; p = 0.061), lower cost (euro8960 vs euro1770; p < 0.0001). Conclusion The ESD cost/revenue balance is negative in 80% of cases. Given the benefits of ESD in terms of patient morbidity and financial savings compared with surgery, the implementation of a specific ESD reimbursement is warranted.