Peristomal Skin Complications Are Common, Expensive, and Difficult to Manage: A Population Based Cost Modeling Study
Peristomal Skin Complications Are Common, Expensive, and Difficult to Manage: A Population Based Cost Modeling Study
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DOI：
10.1371/journal.pone.0037813
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发表时间：
2012-05-24
期刊：
影响因子：
3.7
通讯作者：
Jemec, Gregor Borut Ernst
中科院分区：
文献类型：
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作者：
Meisner, Soren;Lehur, Paul-Antoine;Jemec, Gregor Borut Ernst
背景：造口周围皮肤并发症（PSC）是造口术后最常见的并发症。有造口的生活不仅对患者及其护理人员，而且对整个社会来说都是一个挑战。由于 PSC 评估的方法学问题，中长期并发症的相关健康经济负担很少被描述。 目的：本研究的目的是使用标准化评估造口皮肤工具作为参考，创建一个模型来估计 PSC 的治疗成本。将所得模型应用于现实生活中造口患者的全球数据集 (n = 3017)，以确定 PSC 的患病率和经济负担。方法：采访了 11 名经验丰富的造口护理护士，以全面了解构成成本分析基础的治疗算法。估计费用是基于七周的治疗期。 PSC 成本针对五个基本诊断类别和三个严重程度进行了估计。与轻度病例相比，不同诊断类别的 PSC 的重症 PSC 病例的估计治疗费用增加了 2-5 倍。将法国单位成本应用于全球数据集。 结果：对于有 PSC 的患者 (n = 1742)，七周治疗期（包括器具和配件）的估计总平均成本为 263 ，而对于没有 PSC 的患者 (n = 1172) 则为 215 。协方差分析显示，泄漏水平对 PSC 成本有显着影响，从“很少/从不”到“总是/经常”p < 0.00001 以及从“很少/从不”到“有时”p = 0.0115。 结论：PSC 很常见且很麻烦，而且无论对于患者还是从健康经济学的角度来看，其后果都是巨大的。 PSC 应在早期进行诊断和治疗，以预防长期、使人衰弱且昂贵的并发症。
Background: Peristomal skin complications (PSCs) are the most common post-operative complications following creation of a stoma. Living with a stoma is a challenge, not only for the patient and their carers, but also for society as a whole. Due to methodological problems of PSC assessment, the associated health-economic burden of medium to longterm complications has been poorly described.Aim: The aim of the present study was to create a model to estimate treatment costs of PSCs using the standardized assessment Ostomy Skin Tool as a reference. The resultant model was applied to a real-life global data set of stoma patients (n = 3017) to determine the prevalence and financial burden of PSCs.Methods: Eleven experienced stoma care nurses were interviewed to get a global understanding of a treatment algorithm that formed the basis of the cost analysis. The estimated costs were based on a seven week treatment period. PSC costs were estimated for five underlying diagnostic categories and three levels of severity. The estimated treatment costs of severe cases of PSCs were increased 2-5 fold for the different diagnostic categories of PSCs compared with mild cases. French unit costs were applied to the global data set.Results: The estimated total average cost for a seven week treatment period (including appliances and accessories) was 263 is an element of for those with PSCs (n = 1742) compared to 215 is an element of for those without PSCs (n = 1172). A co-variance analysis showed that leakage level had a significant impact on PSC cost from 'rarely/never' to 'always/often' p < 0.00001 and from 'rarely/never' to 'sometimes' p = 0.0115.Conclusion: PSCs are common and troublesome and the consequences are substantial, both for the patient and from a health economic viewpoint. PSCs should be diagnosed and treated at an early stage to prevent long term, debilitating and expensive complications.